Selected and summarized by Ronald O. Valdiserri, MD, MPH, Professor, Department of Epidemiology, Rollins School of Public Health, Emory University, and Co-Chair of HepVu.
Dr. Valdiserri reviews significant articles on prevention, public health, and policy advances in viral hepatitis. This month, he highlights “Temporal trends and racial/ethnic disparities in hepatocellular carcinoma incidence in the US between 2000-2022.”
What question(s) does this study address?
Cancer prevention may not be the first thought that comes to mind when advocating for viral hepatitis elimination, but untreated infections with Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are among the most important risk factors for the development of hepatocellular carcinoma (HCC), i.e. cancer of the liver. Other risk factors for HCC include obesity, heavy alcohol use, smoking, and type 2 diabetes. The American Cancer Society estimates that in 2026, there will be 42,340 new cases of liver cancer in the U.S. and that nearly 31,000 persons will die from the disease, which has a 5-year survival rate of 22%.
Using data from the SEER-21 (Surveillance, Epidemiology, and End Results) database, these investigators studied trends in the incidence of HCC in the U.S. between 2000—2022, across different racial/ethnic and age groups. Their analysis was limited to persons 30 years of age and older, because the incidence of HCC is extremely low among individuals aged 1-29 years.
What are the major findings of this report/article?
- Between 2000 and 2022, 223,571 cases of HCC were diagnosed among persons aged 30 years and older in the U.S.
- Overall, 76.2% of the HCC cases were male and 23.8% female; the highest number of HCC cases was seen in the age group 60—69 years.
- In total, 48.8% of cases were diagnosed among non-Hispanic Whites, 24.4% were Hispanic, 13.3% were non-Hispanic Black, 12.4% were non-Hispanic Asian/Pacific Islanders, and 0.9% were non-Hispanic American Indian/Alaska Natives.
- The number of incident HCC cases increased from 4,758 in 2000 to a peak of 13,109 cases in 2019, followed by a decline to 11,853 cases in 2022. But despite the recent declining trend, the number of new cases of HCC in 2022 was 2.5 times greater than it was in 2000.
- By 2022, the age-adjusted incidence rate of HCC was highest in Hispanics (17.7 cases per 100,000) and non-Hispanic American Indian/Alaska Natives (16.8 cases per 100,000).
- Comparing age-adjusted incidence rates in 2000 versus 2022 for each racial/ethnic group, the researchers found that non-Hispanic Asian/Pacific Islanders were the only group that had a lower HCC incidence in 2022 than in 2000. For all other racial/ethnic groups their age-adjusted incidence rates were higher in 2022 compared to 2000, as follows: 90.9% increase in non-Hispanic American Indian/Alaska Natives; 63.3% increase in non-Hispanic Whites; 38.3% increase in Hispanics; and 26.7% increase in non-Hispanic Blacks.
What are the implications for the prevention and control of viral hepatitis?
- Since 2000, overall HCC incidence among US persons aged 30 years and older has increased by 54.4% and the incidence has been highest among Hispanic populations since 2012.
- The study showed significant variations in HCC incidence trends across racial/ethnic groups, reflecting the different underlying risk factors leading to the development of liver cancer.
- In the U.S., untreated chronic HBV infection is the major underlying risk factor for HCC in non-Hispanic Asian/Pacific Islander populations. For other racial/ethnic groups in the U.S., untreated Hepatitis C virus infection and fatty liver due to metabolic dysfunction (e.g., type 2 diabetes, high cholesterol, untreated hypertension, etc.) or excessive alcohol use are predominant underlying risk factors.
- Without minimizing the need to improve treatment for the non-infectious, metabolic conditions (e.g., uncontrolled diabetes, untreated hypertension, obesity, etc.) that can lead to HCC, a strong case can be made that expanding efforts to diagnose and treat chronic HBV and chronic HCV infections are important cancer control measures that our nation should support.
