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Disparity in ethnicity, sex persists among increasing liver cancer rates

Liver cancer mortality rates are expected to increase in the coming decades and disparities in occurrence by race, ethnicity, sex and state location in the U.S. continue to persist, according to a recently published study.

“Liver cancer death rates are increasing at a faster pace than any other cancer. A major factor contributing to this increase is the comparatively high prevalence of hepatitis C virus (HCV) infection among those born during 1945 through 1965, also called ‘baby boomers.’ The sustained rise in obesity and type 2 diabetes over the past several decades has also likely contributed to the increasing liver cancer trend,” Farhad Islami, MD, PhD, from the American Cancer Society, Georgia, and colleagues wrote. “The incidence of liver cancer varies by race/ethnicity and state, mainly because of differences in the prevalence of major risk factors and, to some degree, because of disparities in access to high-quality care.”

Based on data available from 2009 to 2013, average annual liver cancer incidence in the U.S. was 7.7 per 100,000 people. Between 2010 and 2014, the annual rate for liver cancer mortality was 6.3 per 100,000 people.

According to data available since 1992 for incidence rates and 1990 for mortality rates, American Indians and Alaskan Natives experienced the highest increase in incidence (15.2 per 100,000) and mortality rates (11.9 per 100,000), compared with the lowest rates seen in Caucasians (6.3 and 5.5 per 100,000, respectively). However, incidence rates did not appear to increase after 2009 among American Indians and Alaskan Natives.

Mortality rates rose by 57% in African-Americans and 69% in Hispanics. Among African-Americans, mortality rates peaked at age 60 to 64 years, compared with 80 to 84 years in all other racial or ethnic groups. Mortality rates were two- to threefold higher among men of all racial or ethnic groups compared with women at both a national and state level.

African-American men had a significantly higher mortality rate compared with Caucasian men in all states except Mississippi, New Mexico, Arkansas and South Carolina, with the highest disparity found in the District of Columbia (fourfold higher).

According to the researchers, approximately 60% of liver cancer cases in the U.S. are attributed to potentially modifiable risk factors, though the proportions vary due to different data sources.

Although the populations with particularly high infection prevalence such as regular drug users and homeless people are underrepresented in most data sources, the researchers found that the overall proportion of hepatocellular carcinoma cases from 2000 to 2011 attributable to HCV was 17% for Caucasians, 21% for Hispanics, 30% for Asians and 36% for African-Americans.

Similarly, the proportion of HCC cases from 2000 to 2011 attributable to HBV was 18% for Asians and less than 3% for Caucasians, Hispanics and African-Americans.

Men have a higher prevalence for being overweight (38%) compared with women (30%), but women are more likely to be obese (40% vs. 30%) and “class 3” obese (10% vs. 6%) than men. Obesity prevalence has substantially increased in all racial and ethnic groups over the period reviewed.

The prevalence for binge drinking, considered four or more drinks per occasion for women and five or more drinks per occasion for men, has increased by 20% in the last decade among individuals age 50 years or older. Compared with Caucasians, self-reported prevalence for binge drinking is similar in African-Americans, lower in Asian and slightly higher among Hispanics.

In general, smoking increases the risk for liver cancer by approximately 50% and the prevalence is highest among American Indians and Alaskan Natives (38%), followed by African-Americans (21%), Caucasians (17%), Hispanics (13%) and Asian/Pacific Islanders (12%). For women, the highest prevalence was also seen in American Indians and Alaskan Natives (24%), followed by Caucasians (16%), African-Americans (13%), Hispanics (7%) and Asian/Pacific Islanders (3%).

“Despite some improvements in localized and regional disease survival rates in the two most recent decades of available data, the overall prognosis for liver cancer remains poor. Wide disparities in liver cancer death rates by sex, race/ethnicity, and state persist, reflecting differences in the prevalence of major risk factors and, to some extent, inequalities in access to high-quality care,” the researchers wrote. “However, most liver cancers are potentially preventable, and interventions to curb the rising burden of liver cancer and reduce racial/ethnic disparities should include the targeted application of existing knowledge in prevention, early detection, and treatment, including improvements in HBV vaccination, screening and treatment of HCV, maintaining a healthy body weight, access to high-quality diabetes care, prevention of excessive alcohol drinking, and tobacco control.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.