Future of Hepatocellular Carcinoma Incidence in the United States Forecast Through 2030

Abstract

Purpose: Hepatocellular carcinoma (HCC) incidence rates have been increasing in the United States for the past 35 years. Because HCC has a poor prognosis, quantitative forecasts could help to inform prevention and treatment strategies to reduce the incidence and burden of HCC.

Methods: Single-year HCC incident case and population data for the years 2000 to 2012 and ages 35 to 84 years were obtained from the SEER 18 Registry Database. We forecast incident HCC cases through 2030, using novel age-period-cohort models and stratifying by sex, race/ethnicity, and age. Rates are presented because absolute numbers may be influenced by population increases.

Results: Rates of HCC increased with each successive birth cohort through 1959. However, rates began to decrease with the 1960 to 1969 birth cohorts. Asians/Pacific Islanders (APIs) have had the highest HCC rates in the United States for many years, but the rates have stabilized and begun to decline in recent years. Between 2013 and 2030, rates among APIs are forecast to decline further, with estimated annual percentage changes of -1.59% among men and -2.20% among women. Thus, by 2030, Asians are forecast to have the lowest incidence rates among men, and Hispanics are forecast to have the highest rates among men (age-standardized rate, 44.2). Blacks are forecast to have the highest rate among women (age-standardized rate, 12.82).

Conclusion: Although liver cancer has long had some of the most rapidly increasing incidence rates, the decreasing rates seen among APIs, individuals younger than 65 years, and cohorts born after 1960 suggest that there will be declines in incidence of HCC in future years. Prevention efforts should be focused on individuals in the 1950 to 1959 birth cohorts, Hispanics, and blacks.

Fig 1.

Observed and projected incidence of hepatocellular carcinoma (HCC; per 100,000 person-years) in SEER 18, overall and by race in (A) males and (B) females. Shaded bands show point-wise 95% confidence limits.

Fig 2.

Age-specific hepatocellular carcinoma incidence rates per 100,000 person-years by decade of birth (cohort), (A) 1895 to 1964, and (B) 1945 to 1969, from SEER 9, 1975 to 2012. *Incidence rates for the most recent surveillance years are underestimated, as they do not include cases from the final birth years of each cohort and are not adjusted for delayed reporting. †Incidence rates for the most historic surveillance years are overestimated, as they do not include cases from the beginning birth years of each cohort.

Fig 3.

Incidence rates (per 100,000 person-years) of hepatocellular carcinoma (HCC) in SEER 18 by calendar period, 2000 to 2012 and 2013 to 2030 in (A) males, and (B) females. Shaded bands show point-wise 95% confidence limits.

Fig 4.

Observed and projected incidence of hepatocellular carcinoma (HCC; per 100,000 person-years) in SEER 18, by age group in (A) males, and (B) females. Shaded bands show point-wise 95% confidence limits.