Liver Cancer Incidence and Deaths Rising, With Wide Ethnic Disparities Interview with:

Farhad Islami, MD PhD  Strategic Director, Cancer Surveillance Research American Cancer Society, Inc. Atlanta, GA 30303

Dr. Islami

Farhad Islami, MD PhD
Strategic Director, Cancer Surveillance Research
American Cancer Society, Inc.
Atlanta, GA 30303 What is the background for this study? What are the main findings?

Response: Liver cancer is one of the leading causes of cancer death in the United States, accounting for nearly 29,000 deaths per year, with variations in occurrence by race/ethnicity and state.

We examined trends in liver cancer incidence, survival, and mortality in the United States and provided liver cancer mortality rates by race/ethnicity at the national and state level. State-level statistics are particularly important as they can inform state cancer control and prevention planning. We also provided detailed information on prevalence and trends in major risk factors for liver cancer and interventions to prevent or reduce their burden, to make our article a comprehensive yet concise source of information on liver cancer statistics, risk factors, and interventions in the United States. What are the main findings?

Response: Our results show an increase in liver cancer incidence and death rates over the past several decades. There is substantial disparity in liver cancer death rates by race/ethnicity (from 5.5 per 100,000 in non-Hispanic whites to 11.9 in American Indians/Alaska Natives) and state (from 3.8 per 100,000 in North Dakota to 9.6 in the District of Columbia). Racial/ethnic disparities in liver cancer mortality exist in most states, including those with relatively low liver cancer death rates (e.g., Minnesota and Utah), in which low rates in whites masked markedly higher rates in racial/ethnic minority groups.

Available information suggests that these disparities are mainly because of differences in the prevalence of major risk factors and, to some degree, because of disparities in access to high quality care. For example, higher prevalence of chronic HCV infection, excess body weight, and nonalcoholic fatty liver disease in Mexican Americans than Hispanics of Cuban or Puerto Rican origin may largely explain higher liver cancer death rates in Texan Hispanics (predominantly of Mexican origin) than Floridian Hispanics (mostly of Cuban or Puerto Rican origin). Although there has been some improvement in survival, notably for early-stage cancers, overall prognosis of liver cancer remains poor, with only one in five patients surviving 5 years. What should clinicians and patients take away from your report?

Response: I believe the most important take-away from this article should be that most liver cancers are potentially preventable. For example, infection with hepatitis C virus (HCV), one of major risk factors for liver cancer in the United States, can be cured, and hepatitis B virus (HBV) vaccination can prevent HBV infection and related liver cancer. Many other liver cancer cases have been attributed to other potentially modifiable risk factors, including obesity, type II diabetes, alcohol drinking, and smoking. Therefore, screening and treatment for chronic HCV infections, improvements in vaccination against HBV, comprehensive programs to reduce transmission of HCV and HBV through high risk behaviors (e.g., using shared syringes), maintaining a healthy bodyweight, access to high quality diabetes care, preventing excessive alcohol drinking, and tobacco control can substantially reduce the burden of liver cancer in the United States. What recommendations do you have for future research as a result of this study?

Response: Although most liver cancers are potentially preventable, many at risk individuals may not be aware of or have access to preventive measures. For example, only 14% of people born in 1945–1965 has reported HCV testing, although one-time HCV testing is recommended for this group; further, only about one-third of those with known HCV infection receive follow-up care, despite availability of curative treatment. More research is needed on tailored implementation of appropriate interventions for different subpopulations at the state and local level. Also, more research is required to improve early detection and treatment of liver cancer and increase in access to appropriate care.

No disclosures Thank you for your contribution to the community.


Islami, F., Miller, K. D., Siegel, R. L., Fedewa, S. A., Ward, E. M. and Jemal, A. (2017), Disparities in liver cancer occurrence in the United States by race/ethnicity and state. CA: A Cancer Journal for Clinicians. doi: 10.3322/caac.21402

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