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Increased Liver Cancer Deaths - new report from CDC
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Download the PDF here
CDC press release March 9 2016 below
Death rates increased among men during 2003 through 2012 for cancers of the liver (2.8% per year)....see Figure 5 below showing the high rates & recently increased rates of death among Baby Boomers and 40-68 years old
Below are a few highlights from the Annual Report to the Nation on the Status of Cancer
⋅ Between 2003 and 2012, the rate of new cases of liver cancer increased by 3.4 percent per year among men and 2.4 percent per year among women.
⋅ Between 2003 and 2012, the liver cancer-related death rate increased by 2.8 per year among men and 2.2 percent per year among women.
⋅ Hepatitis C and liver cancer-associated death rates were highest among those born during 1945-1965; these also represent the majority of Americans with hepatitis C infection.
Unlike most other kinds of cancer, liver cancer incidence and death rates are going up. From 2008 to 2012, the liver cancer incidence rate went up an average of 2.3% per year, and the liver cancer death rate went up by an average of 2.8% per year for men and 3.4% per year for women. About twice as many men as women get liver cancer.
"Annual Report to the Nation: Cancer death rates continue to decline
Increase in liver cancer deaths cause for concern"
http://www.cdc.gov/media/releases/2016/p0309-cancer-death-rate.html
from Jules: you can see the high & increasing death rates of Baby Boomers due to liver cancer in Figure 5 in panel A in 2013, and in Panel B which shows the high and highest death rates in those ages 55-59 and in baby boomers in general HCV and liver cancer-associated mortality from 1999 to 2013 is illustrated in Figure 5. Among persons for whom both HCV and liver cancer were listed as causes of death, those born during 1945 through 1965 had the largest increase in mortality from 1999 to 2013 relative to the other birth-year categories (Fig. 5A). Considering the differences in age between birth cohorts, those born during 1945 through 1965 had substantially higher rates of HCV and liver cancer-associated deaths than the preceding or subsequent birth cohorts, particularly for the mid-generational group (Fig. 5B).
Death rates for most cancer sites declined or were stable from 2003 to 2012 among men and women of each racial and ethnic group, except for liver cancer, which increased for most racial and ethnic groups except for API men and women and AI/AN women
Among both men and women, liver cancer incidence rates increased significantly from 2008 to 2012, beginning at age 55 years, and the largest AAPC [annual percent change] was observed among the group ages 60 to 64 years among men and the group ages 55 to 59 years among women.
State-specific liver cancer incidence rates ranged 3-fold, from 3.3 to 12.5 per 100,000 persons (Fig. 1). Liver cancer incidence rates were highest in Pacific states, in states on the southern US border, in the District of Columbia, and in a few states in the Northeast, including Delaware, Connecticut, Massachusetts, and New York.
The Report to the Nation on the Status of Cancer (1975-2012) shows that death rates continued to decline for all cancers combined, as well as for most cancer sites for men and women of all major racial and ethnic populations. The overall cancer death rates for both sexes combined decreased by 1.5 percent per year from 2003 to 2012. Incidence rates—new cancer cases that are diagnosed per 100,000 people in the U.S.—decreased among men and remained stable for women between 2003 and 2012.
The ongoing drop in cancer incidence in most racial and ethnic groups is due, in large part, to progress in prevention and early detection. Fewer deaths from cancer in those same groups may also reflect better treatments. Tobacco control efforts have contributed to lower rates of lung cancer, the leading cause of cancer death in both men and women, as well as many other types of cancer.
The report also examines trends in liver cancer. In contrast to the trends for most other cancers among both men and women, death rates due to liver cancer have increased the most compared with all cancer sites, and liver cancer incidence rates have also increased sharply.
"The latest data show many cancer prevention programs are working and saving lives," said CDC Director Tom Frieden, MD, MPH. "But the growing burden of liver cancer is troublesome. We need to do more work promoting hepatitis testing, treatment, and vaccination."
Key findings on liver cancer:
⋅ From 2008 to 2012, liver cancer incidence increased an average of 2.3 percent per year overall, and the liver cancer-related death rate increased by an average of 2.8 percent per year among men and 3.4 percent per year among women.
⋅ In all racial and ethnic populations, about twice as many men as women were diagnosed with liver cancer.
⋅ Between 2008 and 2012, liver cancer incidence rates were highest among non-Hispanic American Indian/Alaska Native men followed by non-Hispanic Asian/Pacific Islander men.
⋅ Hepatitis C and liver cancer-associated death rates were highest among those born in 1945-1965; these also represent the majority of Americans with hepatitis C infection.
"Research over the past decades has led to the development of several vaccines that, given at the appropriate ages, can reduce the risk of some cancers, including liver cancer," said Douglas Lowy, M.D., acting director of the National Cancer Institute. "Determining which cancers can be effectively prevented by vaccines and other methods is one of our top priorities at NCI and one which we believe will truly make a difference in cancer incidence and mortality trends."
The authors noted that, in the United States, a major contributing factor to liver cancer is hepatitis C virus (HCV) infection. A little more than 20 percent of the most common liver cancers are attributed to HCV infection. Compared with other adults, people born during 1945-1965 have a six times greater risk of HCV infection. CDC recommends all people born during 1945-1965 receive a one-time test for HCV. Diagnosis of HCV, followed by treatment, can greatly reduce the risk of liver cancer.
"We have the knowledge and tools available to slow the epidemic of liver cancer in the U.S., including testing and treatment for HCV, hepatitis B vaccination, and lowering obesity rates," said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. "We hope that this report will help focus needed attention and resources on liver cancer."
Hepatitis B virus (HBV) infection also increases the risk for liver cancer. HBV is a common risk factor for liver cancer for Asian/Pacific Islander populations, especially among Asians not born in the United States, and CDC recommends universal HBV testing for this population. Fortunately, rates of HBV infection are declining worldwide due to increases in hepatitis B vaccination of children beginning at birth.
Obesity and type 2 diabetes can cause cirrhosis, or scarring of the liver, which can progress to liver cancer and is associated with excessive alcohol use; from 8 to 16 percent of liver cancer deaths are attributed to excessive alcohol use.
"Collecting and analyzing high-quality cancer surveillance data is essential for tracking the benefits of screening and other prevention efforts," said Betsy Kohler, executive director, North American Association of Central Cancer Registries. "Data from an estimated 97 percent of all newly diagnosed cancer cases in the US are used in this report."
The Report to the Nation is released each year in a collaborative effort by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries.
To view the full Report, go to
http://onlinelibrary.wiley.com/doi/10.1002/cncr.29936/full
For a Q&A on this Report, go to
http://www.cdc.gov/cancer/dcpc/research/articles/arn_7512.htm
During 2003 through 2012, the AAPC indicated that overall cancer incidence rates for all persons combined decreased on average 0.7% per year (Table 1). Among men, overall cancer incidence decreased on average by 1.4% per year during 2003 through 2012; however, among women, rates were stable during this 10-year period. Among men, incidence rates for 7 of the 17 most common cancers decreased from 2003 to 2012 (prostate, colon and rectum [colorectal], lung and bronchus [lung], stomach, larynx, urinary bladder [bladder], and brain and other nervous system [brain]). The most striking decline was for prostate cancer, which had an average 6.6% decline per year for the most recent 5-year period (2008-2012). In contrast, incidence rates increased among men during 2003 through 2012 for 8 cancers (thyroid, liver, myeloma, melanoma of the skin [melanoma], kidney and renal pelvis [kidney], leukemia, pancreas, and oral cavity and pharynx). Among women, incidence rates for 6 of the 18 most common cancers decreased during 2003 through 2012 (colorectal, cervix uteri [cervix], lung, bladder, ovary, and stomach), whereas incidence rates among women increased during 2003 through 2012 for 8 cancers (thyroid; liver; corpus and uterus, not otherwise specified [uterus]; kidney; pancreas; melanoma; leukemia; and myeloma). Incidence rates were stable for all other sites.
Among women, during 2003 through 2012, death rates declined overall (1.4% per year) and for non-Hodgkin lymphoma (3.1% per year), colorectal cancer (2.9% per year), leukemia (1.2% per year), and myeloma (1.2% per year), and for cancers of the stomach (2.6% per year), ovary (2.0% per year), breast (1.9% per year), lung (1.4% per year), oral cavity and pharynx (1.3% per year), gallbladder (1.2% per year), kidney (1.0% per year), cervix (0.9% per year), and bladder (0.4% per year), and remained stable for brain cancer, but increased for cancers of the liver (2.2% per year), uterus (1.1% per year), and pancreas (0.4% per year).
Age-specific incidence rates from 2008 to 2012 of liver and intrahepatic bile duct cancer are illustrated by race or ethnicity
for areas in the United States with high-quality incidence data.
Figure 4 illustrates liver cancer incidence rates by age for cases diagnosed during 3 time intervals: 1992 to 1996, 2000 to 2004, and 2008 to 2012. Liver cancer incidence rates in general, as noted above, continued to increase with advancing age for each diagnosis period. However, during 2008 through 2012, liver cancer incidence rates among NH blacks were highest among persons ages 55 to 59 years, who are in the 1953 birth cohort (born during 1948-1957). A similar pattern is observed among NH whites and Hispanics, for whom there was a sharp increase among those ages 55 to 59 years during 2008 through 2012, although liver cancer incidence rates continued to increase with age. Among NH whites, NH blacks, and Hispanics, liver cancer incidence rates were generally highest for the most recent (2008-2012) diagnosis years and lowest for the 1992 to 1996 diagnosis years. Among Hispanics, there was a large difference between diagnosis years for every age; whereas, among NH whites and NH blacks, the largest difference was for those ages 50 to 69 years. The differences by diagnosis year were less pronounced among NH APIs than among other subgroups.
Figure 3 illustrates the cohort rate ratios and 95% CIs by race or ethnicity for liver cancer incidence relative to the experience of the 1943 reference birth cohort. Among NH white, NH black, and Hispanic men and women, the cohort rate ratio was <1.0 for the 1913 to 1938 birth cohorts. The rate ratio then sharply increased for birth cohorts 1948 through 1953. The rate ratio for birth cohorts 1953 through 1968 slightly decreased among NH whites and Hispanics but decreased sharply among NH blacks. In contrast, the cohort relative risk remained unchanged for NH APIs, signifying a minimal birth-cohort effect.
Table 6 presents incidence-based mortality data for liver cancer in the SEER-18 areas during 2008 through 2012. More than half of these deaths (53%) occurred among NH whites. The median age at death from liver cancer was younger among NH blacks (median age, 61 years) and Hispanics (median age, 64 years) than among NH whites (median age, 66 years) and NH APIs (median age, 68 years). The median age at death was 9 years older among women (median age, 72 years) than among men (median age, 63 years), but this difference ranged from 4 years among NH blacks to 10 years among NH APIs. More than 379,000 person-years of life were lost to liver cancer during 2008 through 2012. The average person-years of life that were lost to liver cancer death was higher among NH blacks (average, 22 PYLL) and Hispanics (average, 20 PYLL) than among NH APIs and NH whites (average, 18 PYLL for both). Although 74% of total PYLL were among men, the APYLL was similar among men (19 APYLL) and women (17 APYLL).
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