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Why Liver Cancer Numbers Continue to Increase

Tuesday, July 11th, 2017

The five-year survival rate for people with liver cancer remains at only 20 percent. Diabetes, hepatitis C, smoking, and alcohol are all factors.

Between 2009 and 2013, doctors diagnosed liver cancer in 7.7 people out of every 100,000.

That number has been increasing since the mid-1970s.

In addition, the death rate is rising faster than for any other cancer — it is one of America’s leading causes of cancer death.

Between 2010 and 2014, it stood at 6.3 people per 100,000.

The five-year survival rate is only about 20 percent.

Healthline spoke with Dr. Jack Jacoub, medical oncologist and director of thoracic oncology at MemorialCare Cancer Institute at Orange Coast Memorial Medical Center in California.

He stated that liver cancer is “the second most common cancer killer in the world.”

This month, researchers at the American Cancer Society (ACS) published a groundbreaking study in CA: A Cancer Journal for Clinicians.

During the study, researchers uncovered trends in liver cancer incidence, survival, and mortality rates.

Researchers used Surveillance, Epidemiology, and End Results (SEER) program data obtained from the National Center for Health Statistics.

Read more: Get the facts on liver cancer »

Risk factors

The following risk factors contribute to liver cancer:

Dr. Anton Bilchik, professor of surgery and chief of gastrointestinal research at John Wayne Cancer Institute at Providence Saint John’s Health Center in California, also spoke with Healthline.

Bilchik said “the reason for the increase in primary liver cancer is largely related to the obesity epidemic that we have going on in this country.”

“Whereas hepatitis C used to be the most common cause of liver cancer, the most common cause now is related to nonalcoholic fatty liver disease,” he noted.

Jacoub, meanwhile, believes that hepatitis still poses the greatest risk.

“There is a very big spiking in hepatitis C infection over the past few decades. And that is the predominant risk factor in the United States for liver cancer,” he said.

Jacoub also suggested another risk factor. He cautioned that “anyone who has hereditary iron overload symptoms,” such as hemochromatosis, is at risk.

“[This] iron scenario causes iron overloading of the liver and [that] causes inflammation and scarring and then … cirrhosis,” he said.

“Whenever cirrhosis develops, you’re immediately at risk for liver cancer,” Jacoub explained.

Read more: Symptoms and warning signs of hepatitis C »

The influx of hepatitis C

“The incidence of hepatitis C in the baby boomer population [those born between 1945 and 1965] is as high as 2 to 3 percent,” reported Bilchik. “And it’s been recommended that all baby boomers should be at least checked for hepatitis C, particularly since recently we [now] have drugs that are very effective at curing patients of hepatitis C.”

Bilchik added, “The biggest breakthrough in this field has been the fact that relatively nontoxic antiviral medications are now FDA-approved that can eradicate hepatitis C.”

“The problem,” he said, “is that a very small percentage of baby boomers are being tested, or have been tested.”

Hepatitis B infection is also preventable. And there is an effective vaccine.

Starting in 1982, hepatitis B vaccinations became a part of routine childhood vaccinations.

As a result, in 2015 the vaccination rate among younger people varied from a low of 83 percent in Idaho, to a high of 98 percent in New Hampshire.

However, only 50 percent of older adults in the United States have been vaccinated.

Read more: Western diets are causing obesity in people around the world »

The risk associated with weight

Studies show that liver cancer risk increases by 26 percent for every five point increase in one’s Body Mass Index (BMI).

More men than women are overweight (BMI 25.0-29.9.) However, a greater number of women fall into the categories of obese (BMI 30-39.9), and class 3 obese (BMI 40+).

Bilchik noted, “Non-insulin dependent diabetes and lack of physical activity are often associated and linked to obesity.”

In the United States, 69 percent of adults over age 20 are overweight.

“It’s well known that up to 25 percent of kids, if not more, are overweight, if not obese,” stated Bilchik.

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Indications are that greater weight control intervention can help, especially among children.

Interventions might help reduce obesity levels, type 2 diabetes, and ultimately liver cancer rates.

Read more: Get the facts on alcohol addiction »

Alcohol, tobacco risk factors

Regardless of amount, drinking alcohol increases your risk of liver cancer.

“Not just in alcoholics,” Bilchik noted, “but also in those people that are considered binge drinkers.”

More effort put into alcohol abuse prevention programs may prove beneficial.

Smokers have a higher risk for liver cancer, too.

Tobacco users increase their risk of liver cancer by approximately 50 percent.

Read more: Poverty linked to poor health »

Race, ethnicity make a difference

There are now treatments for hepatitis C, vaccines for hepatitis B, and better public education about the risks of obesity.

As such, one might expect liver cancer rates to be falling.

But they’re not.

Until the publication of the ACS study, it was difficult to find information that explored total liver cancer mortality and survival rates in the United States.

This was also true for liver cancer mortality and survival rates with regard to race and ethnicity.

Regarding the study, Jacoub noted “liver cancer is one of the few cancers that really has extremely dramatic ethnic variations in population variations. And you’re seeing it in this report.”

The researchers found that the death rate for liver cancer in non-Hispanic whites was 5.5 per 100,000 people.

That compared with 8.4 per 100,000 for blacks, 11.9 per 100,000 for American Indians/Alaska Natives, 9.8 per 100,000 for Asian/Pacific Islanders, and 9.1 per 100,000 for Hispanics.

Digging deeper, the analysis showed that liver cancer incidence varies from state to state, and by race and ethnicity within each state.

Much of the disparity is due to a lack of public health education for certain at-risk groups.

Many of these same populations often also have limited access to quality healthcare.

Read more: Are there early signs of kidney cancer? »

Catching cancer early

The five-year survival rate after a diagnosis of liver cancer has been increasing ever since the early 1990s.

The increase, however, varies among racial and ethnic groups.

Generally, non-Hispanic whites have a lower death rate from liver cancer than blacks.

One of the reasons is that non-Hispanic whites are more likely to undergo surgery for their cancer.

Blacks as a group are more likely to lack health insurance, which may cause people to delay testing.

The stage of liver cancer at the time of diagnosis influences the survival rate.

Between 2006 and 2012, people with localized cancers accounted for between 40 and 45 percent of all liver cancer diagnoses. These patients had a survival rate of 37 percent.

That rate dropped to 4 percent for distant stage cancer diagnoses.

When researchers factored race and ethnicity into their analysis of localized disease, they saw a marked difference in survival rates.

It is possible to narrow the gap in survival rates between ethnic and racial groups?

Researchers believe the key is in finding ways to diagnose more liver cancers when they are still in the early, more localized stages.

Read more: Baby boomers changing the healthcare landscape »

Over the hump by 2030?

Death rates are expected to continue rising through 2030, and then begin to fall. Bilchik and Jacoub suggested a few possible reasons for the decline.

Baby boomers are currently the most at-risk generation for hepatitis C. Their numbers will continue to shrink as time passes.

In the meantime, more effective public health education will increase the number of baby boomers who seek out testing for hepatitis C.

Also, public education efforts worldwide should increase the number of people receiving hepatitis B vaccinations.

In time, the costs of treating hepatitis C will decline.

Fast food restaurants will continue the current trend of offering foods that are more nutritious

The number of tobacco smokers should continue to decline.

Jacoub stressed, “It’s important to know your risk profile.”

And Bilchik pointed out, “If you think about it, primary liver cancer is largely preventable because most of the causes of liver cancer are related to lifestyle.”

Henry Sapiecha