A new analysis of liver cancer identifies racial and ethnic disparities and emerging trends in this highly lethal disease, the authors report in the journal Clinical Gastroenterology and Hepatology.
The study, conducted by researchers at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and collaborating organizations, also identified specific potential interventions to improve control and prevention.
They conducted an extensive review of 14,420 confirmed cases of hepatocellular carcinoma (HCC) diagnosed between 2010 and 2018. HCC is the most common form of liver cancer. The data came from the Florida Cancer Registry and two other public sources.
HCC accounts for nearly 80 percent of all liver cancers, according to the National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC). About 25,000 new cases are diagnosed each year, a 48% increase in incidence since 2000. The mortality rate of this disease is extremely high, and the five-year survival rate is only 18%.
However, despite these figures, most studies examining the extent and population breakdown of the disease have limited scope, resulting in significant knowledge gaps.
Sylvester cancer epidemiologist and lead author Paulo Pinheiro explains: “To date, studies examining this cancer burden have been hospital-based and did not take into account potentially high-risk populations, which limits the prevalence of epidemics.” research information.” Studies are subject to selection bias due to referral patterns and insurance, which tends to limit the overall impact on underserved populations. “
Pinheiro, also a professor of epidemiology, noted that liver cancer disproportionately affects people of lower socioeconomic status, as well as immigrants, veterans and incarcerated populations, who are difficult to capture in clinical trials because they get information is limited. health care.
“Therefore, we need truly inclusive population data to determine the causes and patterns of this disease, especially if we are to develop effective prevention and control measures for the most vulnerable,” he said.
Pinheiro and his colleagues attempted to overcome potential bias by using data from three separate population-based sources: the Florida Cancer Registry, their public health agency, and their hospital discharge records. The researchers made new connections between these data sources to calculate incidence rates and trends by cause.
In addition, they took advantage of the vast diversity of Florida’s population, focusing on patterns of detailed racial and ethnic groups, such as Central Americans, Cubans, Dominicans, Mexicans, Puerto Ricans, and South Americans, not just Hispanics Latino/Latino, and African American, Haitian, and West Indian, not just non-Hispanic blacks.
Previous research by Pinheiro and colleagues, as well as researchers elsewhere, has shown that 90 percent of liver cancers are caused by hepatitis B or C virus infection, fatty liver and alcohol-related liver disease. However, many of these studies had limitations or did not delve into the most common causes specific to racial groups.
In this study, the researchers extended previous findings to include more years of data — nine years in this study, compared to two years previously (2014-15) — and ran the data more thoroughly. The analysis added the link of chronic disease biomarkers to viral hepatitis, assessed trends and refined subgroups in black, Hispanic and Asian populations.
Studies have shown that race and place of birth can affect the causes of liver cancer, with significant differences between groups. Differences in liver cancer etiology reflect socioeconomic factors associated with each ethnic group.
Significant differences exist among black, Asian, and Hispanic subgroups (eg, Cuban, Haitian, Chinese, Japanese) and social factors that influence the leading cause of liver cancer.
In 2018, hepatitis C infection and fatty liver disease accounted for 36% and 35% of all liver cancers in men and women, respectively.
Additionally, the study revealed some unexpected findings, including a three-fold difference in rates between Puerto Rican men and Cuban men, with Puerto Rican men higher, proving that lumping all Hispanics together can mask important differences between races.
Filipinos have a higher prevalence of fatty liver, similar to Hispanics. Liver cancer caused by hepatitis B infection is the leading cause of liver cancer not only in Asians but also in Haitian-born blacks.
The cause of the rising liver cancer — fatty liver and alcohol-related — is more prevalent among Hispanics. In contrast, the cause of the decline — primarily hepatitis C — was more prevalent among U.S.-born populations, such as blacks and whites.
The researchers also note that the decline in hepatitis C liver cancer since 2015 may be due to the advent of direct-acting antiviral drugs, while the increase in fatty liver cancer rates reflects rising rates of obesity and diabetes in the general population.
“Going forward, we need to emphasize the importance of screening all adults in Florida and nationwide for hepatitis C and hepatitis B virus infection, especially if they are among those identified by “There is a Cure for Hepatitis C.” high-risk groups and effective control of hepatitis B,” Pinheiro added.
His colleague and co-author Sylvester liver cancer expert Patricia D. Jones, MD, agreed. “Cancer control efforts should begin by expanding screening programs to the most vulnerable groups identified in the study,” he said. “Similar efforts are needed to disseminate educational materials based on these detailed data to health professionals caring for these vulnerable groups. “
Pinheiro, who has studied liver cancer for many years, points out that the demographic epidemiology of liver cancer is complex and often inexplicable until now. “Through this study, we have learned something about this deadly disease,” he concludes.