Nasal Polyps May Increase Risk of Cancer in the Nasal Cavities

Pam Harrison

September 04, 2019

Nasal polyps are common, affecting up to 4% of the general population, and can affect quality of life, but are usually benign.

However, a new study suggests that when they occur in older patients (≥ 50 years) they may increase the risk of developing certain head and neck cancers, in particular, nasal cavity and paranasal sinus (NCPS) cancers and nasopharyngeal cancer.

"There is a broad perception, based on clinical experiences among experts, that nasal polyps are not related to future risk of cancer," write the authors.

"Our findings carefully challenge the current paradigm because the relative risks of NCPS and nasopharyngeal cancers were significantly increased over a longitudinal follow-up," they add.

The study was published online July 3 in the Journal of Allergy & Clinical Immunology.

This was a nationwide, population-based cohort study based on data from Korean National Health Insurance claims that compared 453,892 patients with nasal polyps and 4,583,938 matched controls.

Most of the patients with nasal polyps in this study were diagnosed when they were 40 and 60 years old, the researchers note. In individuals diagnosed when they were 50 years of age or older, they found a significantly increased risk of developing cancer in the nasal areas compared with controls.

After a mean follow-up of 6.2 years, the incidence rate ratios (IRR) of patients with nasal polyps compared with controls was 7.00 (95% CI, 5.28 - 9.25) for NCPS cancer and 1.78 (95% CI, 1.28 - 2.42) for nasopharyngeal cancer.

The most common age at diagnosis was 50 to 59 years for nasopharyngeal cancer and 60 to 69 years for NCPS cancer.

In contrast, the risk of hypopharyngeal and laryngeal cancer — anatomically more distant than NCPS and nasopharyngeal cancer — was not significantly higher among older patients with nasal polyps compared to those without.

For hypopharyngeal cancer, the IRR was 0.93 (95% CI, 0.61 - 1.36) and for laryngeal cancer, the IRR was 1.06 (95% CI, 0.87 - 1.30).

The increased risk of developing cancer in the future was evident only in the older group of patients with nasal polyps (age ≥ 50 years), the authors note. 

However, a history of nasal polyps was not associated with an increased risk of mortality from head and neck cancer of either type, they add.

Multivariate Analyses Controlled for Smoking, Asthma, Allergic Rhinitis

In multivariate analyses, which controlled for smoking, asthma, allergic rhinitis, and other factors, the relative risk of participants with nasal polyps developing NCPS was slightly attenuated, with a hazard ratio (HR) of 6.24, as well as for nasopharyngeal cancer, with an HR of 1.58, compared with controls.

Nevertheless, the association between the presence of nasal polyps and heightened risk of both NCPS and nasopharyngeal cancer remained positive even among participants who had never smoked, they note.

In older individuals, "the nasal polyp–cancer relationships were consistently significant regardless of [the presence] of asthma comorbidity," the investigators point out.

They also observed a trend, albeit weaker, between nasal polyps and certain head and neck cancers and comorbid allergic rhinitis. As they note, allergic rhinitis is another proxy marker for local type 2 inflammation.

"When nasal polyps are found in older patients, the potential risk of NCPS or nasopharyngeal cancer might need to be considered," concludes corresponding author Woo-Jung Song, MD, PhD, division of allergy and clinical immunology, University of Ulsan College of Medicine in Seoul, Korea, and colleagues.

However, they also caution that further studies are needed to elucidate the potential mechanisms between the development of head and neck cancer and the presence of nasal polyps in older patients, as well as to validate any potential causal relationship.

The authors have reported no relevant financial relationships.

J Allergy Clin Immunol. Published online July 3, 2019. Abstract

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