Hepatocellular Carcinoma Continues to Increase in US

Zosia Chustecka

May 07, 2010

May 7, 2010 — The incidence of hepatocellular carcinoma increased significantly in the United States between 2001 and 2006, according to the latest population-based estimates reported by the Center for Diseases Control and Prevention (CDC).

The increase is reported in the May 7 issue of Morbidity and Mortality Weekly Report (MMWR). The report coincides with Hepatitis Awareness Month in the United States, which is in its fifteenth year.

The MMWR report notes that the average annual incidence rate of hepatocellular carcinoma increased significantly, from 2.7 per 100,000 people in 2001 to 3.2 per 100,000 people in 2006, with an average annual percentage change in incidence rate of 3.5%.

The findings indicate continued increases in hepatocellular carcinoma incidence, write the authors, adding that improvements in viral hepatitis services are needed to reverse this trend.

This call for improved action on hepatitis, a leading cause of hepatocellular cancer, echoes the detailed recommendations for action laid out recently in a report from the Institute of Medicine (IOM), as reported by Medscape Oncology.

That IOM report recommended a national strategy for the prevention and control of hepatitis B and C virus infection, pointing out that it disproportionately affects minorities.

The latest figures from the CDC show persistent racial/ethnic disparities, the authors add. The incidence of hepatocellular carcinoma was highest among Asians/Pacific Islanders (7.8 per 100,000 people), followed by blacks (4.2), American Indians/Alaska Natives (3.2), and whites (2.6). The incidence among Hispanics (5.7 per 100,000 people) was nearly double that for non-Hispanics (2.8).

Most Cases Preventable

Hepatocellular carcinoma is the ninth leading cause of cancer death in the United States (and the third leading cause worldwide), the CDC authors note. But most cases could be prevented, they point out.

Chronic hepatitis B and C virus infections account for 78% of all hepatocellular cancer in the United States, and prevention of virus transmission and progression of chronic viral disease has been shown to decrease the incidence of this cancer, they point out.

Improvements in viral hepatitis services and public health surveillance are needed, the authors suggest. These should include full implementation of vaccine-based strategies to eliminate hepatitis B, and screening and care referrals for individuals chronically infected with hepatitis B or C. Most Americans who already have a chronic viral hepatitis are unaware of their infection, the authors point out.

The subject of hepatitis leading to liver cancer — and how it can be prevented — was discussed in some detail when the IOM report was released in January 2010, when detailed plans for action — many involving the CDC — were outlined.

At that time, Andrew Muir, MD, clinical director of hepatology at Duke University School of Medicine in Durham, North Carolina, said that the IOM report highlights "many important issues we see in our clinics."

"Too many patients are unaware they have viral hepatitis, and this makes it difficult to control the spread of these infections and provide appropriate treatment to those infected. Too many patients present to our clinics in the late stages of cirrhosis or with advanced liver cancer. If we could identify these patients sooner, we [would be able to use the effective treatment strategies we have] to help them avoid these devastating complications," Dr. Muir said.

"We need coordinated surveillance and educational programs to aid us in these efforts," he concluded.

MMWR. 2010;59(17);517-520.


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