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Report: Overall cancer incidence down, HCC increases

The overall incidence and mortality rates for cancer have decreased over the years, according to the newly released Annual Report to the Nation on the Status of Cancer.

However, deaths by hepatocellular carcinoma have increased and held the highest rate of all common cancers between 2003 and 2012.

The report was a collaborative effort of the American Cancer Society, CDC, National Cancer Institute and North American Association of Central Cancer Registries, in which cancer incidence and mortality data between 1975 and 2012 were analyzed for long-term and short-term trends. In addition, a separate analysis of HCC incidence was performed. Hepatitis C virus infection and HCC-related mortality rates were analyzed between 1999 and 2013.

Overall, researchers, including A. Blythe Ryerson, PhD, MPH, of the division of cancer prevention and control at the CDC, found that mortality rates for all cancers combined and most cancer sites among both men and women decreased by 1.5% per year between 2003 and 2012 (1.8% for men, 1.4% for women). The incidence rates — new cases of cancer diagnosed per 100,000 people in the U.S. — decreased among men and remained stable for women during this time as well.

A. Blythe Ryerson

According to the report, seven of the 17 most common cancers in men had decreases in incidence rate, including colorectal, lung and bronchus, prostate, stomach, larynx, bladder and brain cancers. For women, six of the 18 more common cancers had decreases in incidence rate that included colorectal, cervix, lung and bronchus, bladder, ovary and stomach cancers.

The decrease in lung cancer incidence is attributed in part to as decrease in tobacco use, according to the report.

HCC-related mortality increased at the highest rate of all cancer sites between 2003 and 2012 among both men and women. However, the rate was three-times higher in men (11.5%) vs. women (3.9%) between 2008 and 2012. HCC incidence increased heavily, second only to thyroid cancer, according to the report. HCC incidence was highest among baby boomers born between 1945 and 1965, a time when HCV was prevalent.

In addition to HCV, other causes of HCC included hepatitis B virus infection, cirrhosis, type 2 diabetes, obesity and overuse of alcohol.

“The good news is that cancer death rates overall are going down … while most cancers are decreasing, we have seen a sharp rise in the burden of liver cancer,” Ryerson told Healio.com/Hepatology. “People at risk for hepatitis C, a viral infection that can cause liver cancer, should get tested and treated. Those at high risk include people born between 1945 and 1965.”

Between 2008 and 2012, liver cancer incidence rates among non-Hispanic white, non-Hispanic black and Hispanic men and women were higher among those born after the 1938 to 1947 birth cohort. Non-Hispanic black men and Hispanic men had the highest average person-years of life lost per death (21 and 20 years, respectively) from HCC, according to the report.

“The latest data show many cancer prevention programs are working and saving lives, but the growing burden of liver cancer is troublesome,” Tom Frieden, MD, director of the CDC, said in a press release from the National Cancer Institute. “We need to do more work promoting hepatitis testing, treatment and vaccination.”

In a separate press release, AASLD commented that there are current tools available to decrease HCC, but a problem could be the availability to patients.

“We have the tools we need to reverse this alarming trend — vaccination for hepatitis B and testing and treatment for hepatitis B and C, but we urgently need to do more to ensure that these tools are available to and used by everyone who needs them,” AASLD said in a joint press release.

“We believe that appropriate testing and screening for viral hepatitis and increased access to care are the correct strategies for reducing liver cancer incidence and mortality rates.”

The researchers concluded, “Cancer incidence and mortality declined among men; and, although cancer incidence was stable among women, mortality declined. [In addition], the burden of liver cancer is growing and is not equally distributed throughout the population.

“Efforts to vaccinate populations that are vulnerable to hepatitis B virus infection and to identify and treat those living with HCV or HBV infection, metabolic conditions, alcoholic liver disease, or other causes of cirrhosis can be effective in reducing the incidence and mortality of liver cancer.” – by Melinda Stevens

Disclosure: The study was funded by the CDC, National Cancer Institute, American Cancer Society and the North American Association of Central Cancer Registries.