Liver cancer rates rising in certain groups despite overall decline

Overall, cancer rates have declined in the United States, but liver cancer is one exception. Research shows that approximately 25,000 men and 11,000 women develop liver cancer each year, a number that has increased by 48% since 2000.

Now a new analysis of liver cancer published Sept. 5 Clinical Gastroenterology and Hepatology, providing insights into emerging trends and racial and ethnic disparities. “Since 2015, the incidence of liver cancer due to hepatitis C has declined (possibly due to the advent of direct-acting antiviral drugs), but the incidence of liver cancer due to fatty liver disease has increased, reflecting the incidence of obesity and diabetes in the general population rates,” said Paulo Pinheiro, MD, epidemiologist at Sylvester Comprehensive Cancer Center in Miami and corresponding author of the new study.

Dr Pinheiro said there was a misconception that rates were stable, when in reality some risks were actually rising and needed to be addressed to enhance prevention efforts. This is particularly important because liver cancer has an extremely high mortality rate, with a five-year survival rate of only 18%.

The study found that race and place of birth influence the cause of liver cancer, with clear differences between groups and even within some groups that are often “lumped together,” the authors write. The differences appear to be related to socioeconomic factors, the authors wrote. .

“Information by subgroup allows us to determine which patient groups are at greatest risk for HCC (hepatocellular carcinoma, the most common type of primary liver cancer), which is an important step in our efforts to address disparities in HCC care,” said Nicole Kim. is an assistant professor and hepatologist at the University of Washington School of Medicine in Seattle who was not involved in the study.

Liver cancer disproportionately affects people with lower incomes and less education

Previous research by Pinheiro and colleagues showed that an estimated 90 percent of liver cancers are caused by hepatitis B or C virus infection, fatty liver disease, and alcohol-related liver disease. But the authors say the limitations or focus of these early studies did not allow for a deeper look at the most common causes specific to racial groups, information that is necessary to develop effective prevention and control efforts for the most vulnerable groups.

Pinheiro noted that liver cancer disproportionately affects people of lower socioeconomic status as well as immigrants, veterans and incarcerated populations, groups that are rarely included in clinical studies because they have limited access to health care.

In this experiment, researchers took advantage of Florida’s rich racial diversity, which allowed them to find detailed patterns among ethnic groups such as Central Americans, Cubans, Dominicans, Mexicans, Puerto Ricans and South Americans. , and not just Hispanics/Latinos. Researchers were equally able to study differences among African Americans, Haitians and West Indians, not just differences among non-Hispanic blacks.

Causes of liver cancer vary significantly among racial groups

The study included 14,420 confirmed cases of hepatocellular carcinoma diagnosed between 2010 and 2018. Data were obtained from the Florida Statewide Cancer Registry and two other public sources. By using three independent sources, the researchers attempted to reduce potential bias.

The researchers found that race and country of birth were associated with different causes of liver cancer, with clear differences between groups that appeared to be related to socioeconomic factors such as income and education.

Pinheiro and his team were somewhat surprised by the different patterns within each broad racial or ethnic group. “We tend to describe everyone as black, Hispanic, Asian, etc., but when it comes to liver cancer, these broad generalizations are not enough,” he said.

Pinheiro said there are significant differences in the causes of liver cancer in specific groups, such as Haitians versus African Americans, Cubans versus Puerto Ricans, and Filipinos versus Chinese.

Other key findings include:

• There was a threefold difference in liver cancer rates between Puerto Rican and Cuban men, with Puerto Rican men having higher rates—evidence that the authors cited as evidence that grouping all Hispanics together can mask major differences between races.
• Similar to Hispanics, Filipinos have higher rates of fatty liver-related cancers.
• Liver cancer caused by hepatitis B infection is the leading cause of liver cancer in Asians and Haitian-born blacks.
• An increasing number of causes of liver cancer (fatty liver disease and alcohol-related) are more common among Hispanics.
• The cause of the decline, primarily hepatitis C, is more prevalent among white and black U.S.-born groups.
• In 2018, hepatitis C infection and fatty liver disease accounted for 36% and 35% of all liver cancers in men and women, respectively.

Pinheiro said it’s important to identify different causes between and within different races because different causes have different effects on preventing liver cancer.

Dr. Kim agreed, noting that in the study, Puerto Rican men had the highest HCC incidence, while West Indies-born black men had the lowest HCC incidence of all study groups.

“Without detailed data, these differences may not be as clear. As the incidence of non-alcoholic fatty liver disease… and HCC associated with alcoholic liver disease continues to increase, it will be particularly important to focus on the subpopulations of patients who are most at risk for these diseases. to minimize further disparities in care,” she said.

Kim added that while the data presented are limited to Florida, the study provides a model for evaluating liver cancer data at other state or national levels.

Study findings highlight importance of hepatitis B and C screening

Pinheiro said the findings should be used to increase awareness of liver cancer and hepatocellular carcinoma among primary care physicians. “All providers should follow CDC recommendations to screen the entire asymptomatic adult population in the United States for hepatitis C and B. Unfortunately, this is not always the case, and even if screening is performed, specific recommendations Tests are also not always done as prescribed,” he said.

“If patients screen positive, they can be referred to a liver specialist and receive treatment for hepatitis C, for which there is a cure, or their hepatitis B can be controlled in a way that reduces their chance of developing liver cancer. The future,” Pinheiro said.

He added that the findings could also be used to raise awareness of specific risks in certain groups that are more likely to develop different liver cancer precursors, such as hepatitis C in Puerto Ricans, hepatitis B in Haitians, and fatty liver disease in Hispanics. liver. .

Interested in getting tested for hepatitis B, hepatitis C, or both? Ask your doctor or health department for details. Home testing kits are also available.