Trends in the incidence of primary liver and biliary tract cancers in England and Wales 1971-2001

Abstract

In the last two decades, mortality from primary liver cancer has increased in the UK. We aimed to determine whether the incidence trends for these cancers were similar and in particular if the increasing occurrence of cholangiocarcinoma has continued. We calculated directly age-standardised incidence rates (using the European standard population) by subsite and histological type for all cancers of the liver, gallbladder and biliary tract in England and Wales from 1971 to 2001, using cancer registry data. The incidence of cancers of the liver, gallbladder and biliary tract increased, with the greatest rise, around 12-fold, in intrahepatic bile duct cancers. The rate of liver cell cancer increased by around 45% in males, but by <10% in females. There were marked reductions in the incidence of gallbladder and extrahepatic bile duct cancer. Cholangiocarcinoma increased around 16-fold and became the most common type of primary liver cancer in females, while hepatocellular carcinoma remained the commonest type in males. The age-specific incidence rates showed that intrahepatic bile duct cancer continued to increase throughout the 1990s in those aged 75 and over, while liver cell cancer decreased in the older age groups. In conclusion, there were increases in the incidence of primary liver cancer, which have been particularly dramatic for intrahepatic bile duct cancer, over the last three decades of the 20th century in England and Wales. There has been a halving in the incidence of gallbladder cancer and a reduction of a third in extrahepatic bile duct cancer.

Figure 1

Trends in age-standardised incidence rates from 1971 to 2001 in England and Wales of all malignant cancers of the liver, gallbladder and biliary tract, by sex (3-year rolling averages). Bars are standard errors.

Figure 2

Trends in age-standardised incidence rates of all malignant cancers of the liver, gallbladder and biliary tract, by subsite from 1971 to 2001 in England and Wales for (A) males and (B) females (3-year rolling averages). Liver cell cancer (LCC); cancer of the intrahepatic bile ducts (IHBD); cancer of the liver, unspecified (LUS); cancer of the gallbladder (GB); cancer of the extrahepatic bile ducts (EHBD); and cancer of other parts of the biliary tract (OPBT). For ICD site codes, see Table 1a.

Figure 3

Trends in age-specific incidence rates in males from 1971 to 2001 in England and Wales of (A) liver cell cancer, (B) cancer of the intrahepatic bile ducts, (C) cancer of the gallbladder and (D) cancer of the extrahepatic bile ducts (3-year rolling averages).

Figure 3

Trends in age-specific incidence rates in males from 1971 to 2001 in England and Wales of (A) liver cell cancer, (B) cancer of the intrahepatic bile ducts, (C) cancer of the gallbladder and (D) cancer of the extrahepatic bile ducts (3-year rolling averages).

Figure 4

Trends in age-standardised incidence rates of all malignant cancers of the liver, gallbladder and biliary tract by histological type from 1971 to 2001 in England and Wales for (A) males and (B) females (3-year rolling averages). For histology codes, see Table 1b.