Attributable Causes of Liver Cancer Mortality and Incidence in China

Jin-Hu Fan,Hao Liang,Jian-Bing Wang,Yong Jiang,Wang Xiang,Wen-Qiang Wei,Paolo Boffetta,You-Lin Qiao

doi:10.7314/apjcp.2013.14.12.7251

Abstract

To estimate the proportion of liver cancer cases and deaths due to infection with hepatitis B virus (HBV), hepatitis C virus (HCV), aflatoxin exposure, alcohol drinking and smoking in China in 2005. Systemic assessment of the burden of five modifiable risk factors on the occurrence of liver cancer in China using the population attributable fraction. We estimated the population attributable fraction of liver cancer caused by five modifiable risk factors using the prevalence data around 1990 and data on relative risks from meta-analyses, and large-scale observational studies. Liver cancer mortality data were from the 3rd National Death Causes Survey, and data on liver cancer incidence were estimated from the mortality data from cancer registries in China and a mortality/incidence ratio calculated. We estimated that HBV infection was responsible for 65.9% of liver cancer deaths in men and 58.4% in women, while HCV was responsible for 27.3% and 28.6% respectively. The fraction of liver cancer deaths attributable to aflatoxin was estimated to be 25.0% for both men and women. Alcohol drinking was responsible for 23.4% of liver cancer deaths in men and 2.2% in women. Smoking was responsible for 18.7% and 1.0% . Overall, 86% of liver cancer mortality and incidence (88% in men and 78% in women) was attributable to these five modifiable risk factors. HBV, HCV, aflatoxin, alcohol drinking and tobacco smoking were responsible for 86% of liver cancer mortality and incidence in China in 2005. Our findings provide useful data for developing guidelines for liver cancer prevention and control in China and other developing countries.

Highlights

Liver cancer is the 5th most common cancer in men worldwide, and over 85% of liver cancers occur in developing countries (Ferlay et al, 2010)
Since part of the material (PAF for smoking (Wang et al, 2010), alcohol drinking (Liang et al, 2010), infection (Xiang et al, 2011), and aflatoxin (Liu et al, 2012)) has already been published, this paper focuses on the joint effects of these risk factors on liver cancer and a comparison of these joint effects with those found in other similar studies
Statistical analysis The population attributable fraction (PAF) was calculated based on the relative risk of a risk factor (RR) and the prevalence of exposure to the risk factor in the total population (P) using the following formula, by Levin (Levin, 1953): PAF

Summary

Introduction

Liver cancer is the 5th most common cancer in men worldwide, and over 85% of liver cancers occur in developing countries (Ferlay et al, 2010). In China, liver cancer ranks as the 2nd most common cause of cancer death, with mortality rates of 37.5/100, 000 in men and 14.4/100, 000 in women (Chen et al, 2010). One report estimated that HBV and HCV infection, tobacco smoking and alcohol drinking were responsible for 92% of liver cancer deaths in both men and women in Japan in 2005. One meta-analysis, reported in a Chinese journal, has estimated the fraction of liver cancer attributable to lifestyle risk factors in China, including HBV, HCV, aflatoxin, smoking, drinking, family history of cancer, and vegetable and fruit intake, but it did not estimate the combined population attributable fraction (PAF) (Yao et al, 2002). We previously conducted a project, aimed at estimating the role of known risk factors of cancer, such as smoking and alcohol drinking, on the cancer burden in China in 2005 (Wang et al, 2012a), which gave us the opportunity to estimate the PAF for relevant risk factors and liver cancer

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Conclusion