The changing pattern of epidemiology in hepatocellular carcinoma

Abstract

Primary liver cancer (PLC) represents approximately 4% of all new cancer cases diagnosed worldwide. The purpose of this review is to describe some of the latest international patterns in PLC incidence and mortality, as well as to give an overview of the main etiological factors. We used two databases, GLOBOCAN 2002 and the World Health Organization (WHO) mortality database to analyze the incidence and mortality rates for PLC in several regions around the world. The highest age adjusted incidence rates (>20 per 100,000) were reported from countries in Southeast Asia and sub-Saharan Africa that are endemic for HBV infection. Countries in Southern Europe have medium-high incidence rates, while low-incidence areas (<5 per 100,000) include South and Central America, and the rest of Europe. Cirrhosis is present in about 80-90% of HCC patients and is thereby the largest single risk factor. Main risk factors include HBV, HCV, aflatoxin and possibly obesity and diabetes. Together HBV and HCV account for 80-90% of all HCC worldwide. HBV continues to be the major HCC risk factor worldwide, although its importance will most likely decrease during the coming decades due to the widespread use of the HBV vaccine in the newborns. HCV has been the dominant viral cause in HCC in North America, some Western countries and Japan. Obesity and diabetes are increasing at a fast pace throughout the world, and if they are proven to be HCC risk factors, they would account for more HCC cases in the future.

Fig. 1

Age-standardized incidence rates of primary liver cancer worldwide, estimated for 2002. Source: GLOBOCAN 2002, with estimates for 2002. The Age-Standardized Rate is calculated using the 1960 world standard population in 5 age-groups 0–14, 15–44, 45–54, 55–64, 65+.

Fig. 2

Age-standardized incidence rates of primary liver cancer, per 100,000 population at risk. Source: GLOBOCAN 2002, with estimates for 2002. The Age-Standardized Rate is calculated using the 1960 world standard population in 5 age-groups 0–14, 15–44, 45–54, 55–64, 65+.

Fig. 3

Percentage of age-standardized cancer mortality due to primary liver cancer in selected countries, by sex. Source: GLOBOCAN 2002, with estimates for 2002. The Age-Standardized Rate is calculated using the 1960 world standard population in 5 age-groups 0–14, 15–44, 45–54, 55–64, 65+.

Fig. 4

Age distribution of primary liver cancer mortality (per 100,000) in select examples of high-, middle- and low-incidence countries. Source: WHO mortality database. M: Male, F: female.