Survey of primary liver tumors and oral contraceptive use

Abstract

The American College of Surgeons' survey data on 378 female and 165 male cases of primary liver tumors reported by 477 hospitals in the United States during 1970--1975 are presented. In males, 91.5% of the tumors were malignant, confirming the rarity of benign liver tumors in males. Among females, 43.9% were malignant and 56.1% were benign. Of the 212 benign tumors, 96 were hepatic cell adenomas and 58 were focal nodular hyperplasias. A positive history of oral contraceptive use was found in nearly half of all tumors, 65% of benign tumors, 74% of hepatic cell adenomas, and 74% of focal nodular hyperplasias. High frequencies of benign tumors were observed in the age group 20--30 yr. More than 80% of the tumors in this age group were found in oral contraceptive users. Symptomatology was more severe among users. No case of intraperitoneal bleeding was observed in nonusers. The findings confirm the suggested association between use of oral contraceptives and hepatic cell adenomas and focal nodular hyperplasias.

PIP: The American College of Surgeons conducted a survey of primary liver tumors in cancer-approved hospitals throughout the U.S. in the 6-year period, 1970-75. Of the 165 male cases identified, 91.5% were malignant, indicating the rarity of benign liver tumors in males. Of the 378 female cases located, 43.9% were malignant and 56.1% were benign. Nearly 50% of all primary liver tumors were found in women with a positive history of OC (oral contraceptive) usage, with OC history unknown in 29% of the study population. OC users accounted for 65% of all benign tumors reported, 74% of all hepatic cell adenomas, 74% of all focal nodular hyperplasias, 80% of benign tumors in the 20-30 year age group, and almost 90% of hepatic cell adenomas in the age group 26-30. This incidence survey confirms the reported association between OC usage and some types of benign liver tumors, especially hepatic cell adenomas and focal nodular hyperplasias. It is pointed out, and illustrated with graphs, that the age pattern for benign tumores corresponds to the age pattern for OC use. More of the OC users who developed benign tumors had used mestranol, results confirming earlier reported associations. However, this may simply be due to the fact of mestranol's earlier availability. Symptomatology, particularly with regard to pain and mass, was more pronounced in OC users. Results on duration of OC use and any association with tumor development were inconclusive. The incidence of benign liver tumors has increased from 1970 to 1975.