An extensive review of 14,420 conﬁrmed cases of hepatocellular carcinoma (HCC), the most common form of liver cancer, diagnosed between 2010 and 2018, has identified racial and ethnic differences and emerging trends for this highly fatal disease. The study by researchers with Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and collaborating organizations, also identiﬁed potential targeted interventions to improve control and prevention. The report, which used data culled from Florida’s statewide cancer registry and two other public sources, was published in Clinical Gastroenterology and Hepatology.
According to statistics from the National Cancer Institute (NCI) and Centers for Disease Control and Prevention (CDC), HCC accounts for almost 80 percent of all liver cancers. About 25,000 new cases are diagnosed annually, and its incidence has increased 48% since 2000. The disease is highly fatal, with a ﬁve-year survival rate of only 18%.
Despite these numbers, however, most studies looking at the extent and demographic breakdown of the disease have been limited in scope, resulting in a clear knowledge gap.
“To date, studies examining the burden of this cancer have been hospital-based, failing to consider the underlying population at risk, thereby limiting epidemiological information,” explained Paulo Pinheiro, MD, PhD, a Sylvester cancer epidemiologist and the study’s corresponding author. “Hospital studies are subject to selection bias due to referral and health insurance patterns, which tend to limit the overall impact on marginalized populations.”
Pinheiro, who is also a professor of epidemiology, noted that liver cancer disproportionately affects people of low socioeconomic status, as well as immigrants, veterans and incarcerated populations, which are difﬁcult to capture in clinical studies because they have limited access to healthcare.
“Consequently, we need truly inclusive population data to establish causes and patterns for this disease, especially if we are to develop effective prevention and control efforts for those most vulnerable,” he said.
Pinheiro and colleagues sought to overcome potential biases by using data from three independent, population-based sources: Florida’s cancer registry; its public health agency; and its hospitals’ discharge records. The researchers deployed novel linkages among these data sources to estimate incidence and trends by cause.
Additionally, they leveraged the vast diversity of Florida’s population to focus on patterns in detailed racial-ethnic groups, such as Central Americans, Cubans, Dominicans, Mexicans, Puerto Ricans and South Americans, instead of Hispanic/Latino only, and African American, Haitian and West Indian instead of just Non-Hispanic Black.
Previous studies done by Pinheiro and collaborators at Sylvester and researchers elsewhere have shown that 90% of all liver cancers are caused by hepatitis B or hepatitis C viral infections, fatty liver disease and alcohol-related liver disease. However, many of those studies had limitations or did not dig deeper into the most common causes speciﬁc to racial-ethnic groups.
For this study, the researchers expanded on past ﬁndings by including more years of data – nine in this study versus only two (2014-15) previously – and conducting a far more comprehensive analysis of the data, adding linkages for chronic viral hepatitis biomarkers, performing trend assessments and reﬁning subgroups for Black, Hispanic and Asian populations.
Key ﬁndings from the study included:
Additionally, the research revealed some unexpected ﬁndings, including:
The researchers also noted that declines in liver cancer from hepatitis C since 2015 are likely due to the advent of direct-acting antivirals, while increasing incidence of liver cancer from fatty liver disease reﬂect rising rates of obesity and diabetes in the general population.
“Moving forward, we need to reinforce the importance of screening all adults in Florida – and nationwide –for hepatitis C and B viral infections, especially if they are in a high-risk group identiﬁed by the study,” Pinheiro said. “There is a cure for hep C and an effective control for hep B.”
Colleague and co-author Patricia D. Jones, MD, a Sylvester liver-cancer specialist, agreed. “Cancer Control efforts should begin by expanding screening programs to the most vulnerable groups noted in the study,” she said. “Similar efforts are critically needed to disseminate educational materials informed by this granular data to the healthcare providers who care for these vulnerable groups.”
Pinheiro, who has been studying liver cancer for many years, noted that its epidemiology by demographics is quite complex and, until now, often puzzling. “With this study, we have shined some light on this deadly disease.”Back To Top
Race, Ethnicity May Impact Cause of Liver Cancer. Appl Rad Oncol.