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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Increasing Rates of Primary Liver Cancer in the United States
18 November 2003 | Volume 139 Issue 10 | Page I-28
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "The Continuing Increase in the Incidence of Hepatocellular Carcinoma in the United States: An Update." It is in the 18 November 2003 issue of Annals of Internal Medicine (volume 139, pages 817-823). The authors are H.B. El-Serag, J.A. Davila, N.J. Petersen, and K.A. McGlynn.
What is the problem and what is known about it so far?
Primary liver cancer is a cancer that starts in the liver rather than a cancer that starts elsewhere and spreads to the liver. Most types of primary liver cancer arise from abnormal cells in the liver (hepatocellular carcinoma). The exact cause of the abnormal cells is unclear, but most people with primary liver cancer also have liver scarring (cirrhosis) and some have had chronic viral infections of the liver (hepatitis B or C) for 20 to 40 years or heavy alcohol drinking for several years. The number of people in the United States with a diagnosis of primary liver cancer started increasing in the early 1980s. Reasons for the increase were unclear. Some researchers thought that the increase might be due to the rise in hepatitis C virus infections that occurred during the 1960s and 1970s. These infections were spread by needle sharing among intravenous drug users, transfusion of unscreened blood products, and unsafe sexual practices. If these infections were related to liver cancer, cancer rates might continue to increase for many years, particularly in groups that were exposed to hepatitis C virus in the 1960s and 1970s.
Why did the researchers do this particular study?
To see whether rates of liver cancer (hepatocellular carcinoma) have continued to increase in the United States.
Who was studied?
People who received a diagnosis of liver cancer between 1975 and 1998.
How was the study done?
The researchers used a national database that covers 9 geographic regions in the United States. The database has information about patients who received a cancer diagnosis and their outcomes. The information is obtained from routine review of medical records. The researchers looked at whether numbers of new cases of liver cancer increased from the 1970s to the 1990s and whether rates of any increases were leveling off.
What did the researchers find?
Incidence rates of liver cancer doubled from 1975 to 1998. Increasing rates were seen in all ethnic groups and in most age groups after 40 years of age. Black people and older people had the highest incidence rates, but the largest recent increases in rates (from 1995 to 1998) were in white men 45 to 54 years of age.
What were the limitations of the study?
Because the geographic regions covered by the database are mostly urban, data may not apply to people who live in rural areas. Patients were classified as white, black, or other. This limited the ability to look at rates of cancer in groups such as Hispanic persons and Asian persons. Because no blood tests for hepatitis C virus infections were available, no direct linkages between these infections and liver cancer could be made.
What are the implications of the study?
The number of cases of liver cancer in the United States is still increasing rapidly, especially among white men 45 to 54 years of age. The increases may be explained by hepatitis C virus infections acquired in the 1960s and 1970s.
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