After more than a decade of increases, new cases of liver cancer among people with hepatitis C in New York City are beginning to decline with the advent of effective antiviral treatments, according to research presented at IDWeek 2023. , there is still a need for improved screening and surveillance.
Over years or decades, chronic hepatitis B virus (HBV) or hepatitis C virus (HCV), fatty liver disease, heavy drinking, and other causes of liver damage can lead to serious complications, including liver fibrosis, Cirrhosis and hepatocellular carcinoma (HCC), the most common types of primary liver cancer.
Direct-acting antiviral drugs, first approved in late 2013, can cure more than 90 percent of people with hepatitis C. Curing hepatitis C can halt disease progression and possibly even reverse some liver damage, but people who already have cirrhosis when starting treatment are still at risk of developing liver cancer. Therefore, HCV screening is important in order to diagnose and treat the disease before it progresses. In addition, regular HCC surveillance is recommended for patients with hepatitis C and cirrhosis, as well as for certain patients with hepatitis B, to detect liver cancer at an earlier, more treatable stage.
Ned Latham, MBBS, MPH, and colleagues from the New York City Department of Health and Mental Hygiene and the New York State Department of Health analyzed the latest trends in viral hepatitis and hepatocellular carcinoma in New York City (NYC). It is estimated that 243,000 urban residents have chronic hepatitis B and 86,000 urban residents have chronic hepatitis C, accounting for approximately 3% and 1% of the total population respectively.
Researchers generated a retrospective cohort of New York City residents with HCC by matching New York State cancer registry data with New York City health department viral hepatitis surveillance data. They include all HCC cases diagnosed between 2001 and 2018, except cases reported only by Department of Veterans Affairs hospitals or state cancer registries.
During this period, 13,209 New York City residents were diagnosed with HCC. Of these, 5,379 (41%) had hepatitis C; 2,456 (19%) had hepatitis B; and 282 (2%) had HBV and HCV co-infection. Overall, more than 60% of HCC patients suffer from viral hepatitis. Men account for 75% of all cases, and the average age at diagnosis is 63 years. Overall, 30% of cases occurred among Latinos (who are more likely to develop fatty liver disease), 27% among whites, 23% among blacks, and 20% among Asians and Pacific Islanders. Whites, blacks and Latinos are more likely to be infected with hepatitis C, while Asians are more likely to be infected with hepatitis B.
New cases of HCC increased from 495 in 2001 to a peak of 878 in 2012. During this period, the number of cases in patients with hepatitis B and HBV/HCV co-infection remained relatively stable. The number of cases in people without viral hepatitis fell until 2009, and then began to rise again. While liver cancer cases in people with hepatitis C rose steadily until 2012, the year before direct-acting antiviral drugs debuted, they then plateaued and declined between 2016 and 2018.
The study also showed a trend toward earlier liver cancer diagnoses over time, although 16% of cases were diagnosed as metastatic cancer. The proportion of liver cancer cases diagnosed in the localized stage, when the cancer was still confined to the liver, increased from 48% to 61% among patients with hepatitis B, from 53% to 59% among patients with hepatitis C, and from 53% to 59% among patients with hepatitis C. That rose from 41% to 58% among people without viral hepatitis.
“Recent declines in HCC incidence among New York City residents reflect declines in HCC co-occurring HCV cases,” the study authors concluded. “Despite an increase in the proportion of liver cancer cases diagnosed at the local stage, opportunities for improved screening remain. Targeted Additional analyzes of antiviral treatment, cirrhosis, alcohol intake, and mortality will help further inform HCC prevention efforts.”
These findings are consistent with reports that the etiology of liver cancer is changing. Hepatitis B is now preventable with a vaccine (recommended for all babies), hepatitis C is easily curable, and an increasing number of liver cancers are caused by fatty liver disease, which is increasing along with obesity. Although this study did not directly link individual treatment status to HCC outcomes, the decline in case numbers following the advent of effective treatments is instructive. It can take years to develop liver cancer, and more people with hepatitis C have been cured since 2018, so recent data may show further declines. However, a large proportion of people are unaware that they have HCV, and only third parties are successfully treated.
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