Abstract
PurposeLiver cancer incidence continues to increase while incidence of most other cancers is decreasing. We analyze recent and long-term trends of US liver cancer incidence by race/ethnicity and sex to best understand where to focus preventive efforts.MethodsLiver cancer incidence rates from 1992 to 2016 were obtained from the Surveillance, Epidemiology, and End Results registry. Delay-adjusted age-standardized incidence trends by race/ethnicity and sex were analyzed using joinpoint regression. Age-specific incidence was analyzed using age-period-cohort models. Hepatitis C seroprevalence by cohort was calculated using National Health and Nutrition Examination Survey data.ResultsLiver cancer incidence has peaked in males and Asian or Pacific Islanders. Hispanic males, a high-incidence population, are experiencing a decrease in incidence, although not yet statistically significant. In contrast, incidence continues to increase in females, although at lower rates than in the 1990s, and American Indian/Alaska Natives (AI/ANs). Liver cancer incidence continues to be higher in males. Non-Hispanic Whites have the lowest incidence among racial/ethnic groups. Trends largely reflect differences in incidence by birth-cohort, which increased considerably, particularly in males, for those born around the 1950s, and continues to increase in females and AI/ANs. The patterns in males are likely driven by cohort variations in Hepatitis C infection.ConclusionsLiver cancer incidence appears to have peaked among males. However, important differences in liver cancer trends by race/ethnicity and sex remain, highlighting the need for monitoring trends across different groups. Preventive interventions should focus on existing liver cancer disparities, targeting AI/ANs, females, and high-incidence groups.
Highlights
Liver cancer is the second most common cause of cancerrelated deaths worldwide [1]
Our study shows that overall liver cancer incidence has peaked in males, while it continues to increase in females, but at a lower rate than in the 1990s
The incidence rates among American Indian/Alaska Natives (AI/ANs) are increasing considerably in both males and females and have overtaken APIs as the racial/ethnic group facing the highest burden of liver cancer incidence
Summary
Liver cancer is the second most common cause of cancerrelated deaths worldwide [1]. In 2013, liver cancer had the 8th highest death rate among cancers in the US [2], with some of the fastest growth in mortality (fastest among males [2.8 average annual percent change, AAPC] and second fastest among females [2.7 AAPC], 2010–2014) and incidence (fastest among males [2.8 AAPC] and among females [3.8 AAPC], 2010–2014) [3]. In part because of widespread HBV vaccination programs in the US [10, 11] and the patterns of HCV infection among “baby boomers” (born between 1945 and 1965) and high risk populations [12,13,14], the attributable fraction of liver cancers due to HBV (16%) and HCV (48%) in the US is very different from most other regions in the world [9] Chronic liver diseases such as cirrhosis [6, 7, 9, 15] and non-alcoholic steatohepatitis [5, 7, 15, 16] are other common precursors to liver cancer. The distribution of these risk factors within the US and across the globe may help explain global differences in the trends of liver cancer
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