More People Getting Liver Cancer, Study Finds
by John C. Martin
Article Date: 12-17-03
More people than ever are acquiring primary liver cancer,
to a study from doctors in Houston.(1)
The study focused on hepatocellular carcinoma (HCC), the most
primary malignant tumor of the liver. People infected with
hepatitis B or C, or cirrhosis, face a substantially increased
of developing this cancer.(2)
The disease begins in the cells that make up the liver, and
either as a single tumor, or expands to other parts of the
later. It's estimated that three out of every four primary
cancers are hepatocellular carcinoma.(3)
The cause of this type of cancer is still unclear, but it
arise in people with not only chronic hepatitis infection, but
those who have spent several years drinking heavy alcohol.(4)
'A Continuing Rise'
In their study, a follow-up to research conducted in 1999(5),
doctors at the Veterans Affairs Medical Center and Baylor
Medicine in Houston used a national database that covers nine
geographic regions of the U.S. The database included
about patients who had been diagnosed with hepatocellular
as well as their outcomes. The investigators used that
to determine whether numbers of new cases of liver cancer
from the 1970s to the 1990s, and whether any increases had
They found that the number of people diagnosed with primary
cancer had doubled between 1975 and 1998. In fact, they
that increases were seen in all ethnic groups, and in most age
groups over age 40.
A 1999 study published by the same team found similar trends,
since they had theorized that the rise in liver cancer cases
partly linked to hepatitis C infections, "we expected to
continuing rise in HCC for several more years," said
Serag, M.D., M.P.H., an assistant professor of medicine at
College of Medicine, and a study investigator, in an e-mail
In their earlier study, El-Serag and a colleague found rising
of hepatocellular carcinoma between 1976 and 1995, using
from an epidemiology database.(5)
In their most recent research, the researchers discovered that
incidence of hepatocellular carcinoma jumped from about 1.5
for every 100,000 people between 1975 and 1977 to three cases
100,000 population between 1996 and 1998, the last two years
examined in the study.
"There was a 25% increase during the last 3 years of the
compared with the preceding three years (1993 to 1995),"
The highest incidence of hepatocellular carcinoma was in black
older people, but men between the ages of 45 and 54 had, by
largest recent upswing in liver cancer rates.
The number of people diagnosed with hepatocellular carcinoma
climbing in the early 1980s, but the reasons were not known.
experts have suggested that the cause might be related to the
increase in hepatitis C infections that began in the 1960s and
That's when Hepatitis C Virus infections were spread primarily by
among intravenous drug users, transfusion of unscreened blood
products, and unsafe sexual practices.
Other studies also found "an increase in Hepatitis C Virus-associated
the 1990's, while at the same time, HBV-related-and
HCC remained relatively stable," El-Serag pointed out,
suggesting a link between rising liver cancer rates and the
increasing incidence of hepatitis C.
Despite the apparently definitive findings, the Houston
investigators admitted several weaknesses of their study. For
the geographic regions covered in the research were mostly
information about people with liver cancer living in rural
In addition, patients in the study were classified as white,
or "other", limiting the ability to measure rates of
specifically among Hispanics or Asian-Americans. And because
blood tests for hepatitis C virus infections were available,
investigators were not able to make any direct connections
liver cancer and hepatitis infections.
Controlling the rise in liver cancer cases is
"unfortunately" out of
reach, El-Serag told Priority Healthcare. "Therapy for
Hepatitis C Virus has the
potential of reducing the incidence of HCC, but given its
effectiveness and the small proportion of patients who are
to receive and tolerate it, it is unlikely to have a massive
enough to counter the current trends," he said.
It's been estimated that about 17,300 new cases of primary
cancer and bile duct cancer would be diagnosed in the U.S. in
Of those, approximately 14,400 were expected to die from the
1. El-Serag HB et al. The continuing increase in the incidence
hepatocellular carcinoma in the United States: An Update. Ann
Med 2003 Nov 18;139(10):817-23.
2. American Liver Foundation.
3. American Cancer Society.]
4. American College of Physicians.
5. El-Serag HB, Mason AC. Rising incidence of hepatocellular
carcinoma in the United States. N Engl J Med 1999 Mar