Herpes zoster has been associated with immune suppression, as has an increased risk of cancer. To determine whether patients with herpes zoster are at increased risk for subsequent cancer, we followed 590 residents of Rochester, Minnesota, for 9389 person-years after the diagnosis of herpes zoster. Subsequent relative cancer risks, overall and by specific site, were determined for the entire cohort and selected subgroups. In addition, relative risks of cancer during various intervals after the diagnosis of herpes zoster were determined. The overall relative risk was 1.1 (95 per cent confidence interval, 0.9 to 1.3). Relative risks for specific cancer sites were not different from unity except for those for colon and bladder tumors in women, both of which were slightly elevated. Patients with disseminated, recurrent, or gangrenous zoster, with postherpetic neuralgia, and with ophthalmic zoster were not at elevated risk for subsequent cancer. These findings do not support the investigation of patients for occult cancer at the time of diagnosis of herpes zoster or enhanced surveillance for cancer after such a diagnosis. (N Engl J Med. 1982; 307:393–7.) HERPES zoster has been associated with immunosuppressed states, such as advanced age,1 leukemia,2 lymphoma,2 and chemotherapy.2 The risk of cancer is also said to be elevated among immunodeficient patients.3 Consequently, one might expect to find an elevated prevalence of cancer or an increased incidence of subsequent cancer, or both, among patients diagnosed as having herpes zoster, but data on this point are confusing. Some claim that malignant disease is not more frequent among patients with herpes zoster.4,5 Others disagree. Merselis et al. found a 16 per cent prevalence of neoplasia among patients with localized herpes zoster seen in a hospital.
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