Hepatocellular Carcinoma Incidence Is Decreasing Among Younger Adults in the United States

Abstract

Background & aims: Incidence rates for hepatocellular carcinoma (HCC) increased rapidly in the United States since the 1990s, but have plateaued or started to decrease in other industrialized countries. It unclear if and when a similar trend will be observed in the United States. We examined trends in HCC incidence rates in the United States by age, sex, and race/ethnicity of patients.

Methods: We calculated age-adjusted HCC incidence rates using data from the Surveillance, Epidemiology, and End Results program of cancer registries from 1992 through 2015. We estimated incidence rates by 10-year age group and used joinpoint regression to quantify the magnitude and direction of trends, overall and by sex and race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and Asian/Pacific Islander).

Results: HCC incidence increased by 4.8% per year from 1992 through 2010 (from 4.1 per 100,000 to 9.4 per 100,000) but then started to plateau (annual percentage change, -0.7; 95% CI, -2.0 to 0.7). Incidence rates steadily increased among persons 60 years or older in all racial/ethnic groups except Asian/Pacific Islanders 70 to 79 years old. In contrast, incidence rates decreased in younger and middle-aged adults, in men and women of all races/ethnicities, beginning in the mid-2000s. Rates decreased by 6.2% per year in persons 40 to 49 years old and by 10.3% per year in persons 50 to 59 years old. Annual decreases in incidence were larger among middle-aged blacks (17.2% decrease per year since 2012) compared with adults of the same age in other racial/ethnic groups.

Conclusions: In an analysis of data from the Surveillance, Epidemiology, and End Results program of cancer registries from 1992 through 2015, we found the incidence of HCC to be decreasing among younger and middle-aged adults in the United States, regardless of sex, race, or ethnicity. It is unclear whether current decreases in incidence will reduce the burden of HCC in the future.

Keywords: Epidemiology; Liver Cancer; Prevalence; SEER.

Figure 1.

Annual percent change (APC) in age-adjusted incidence rates of hepatocellular carcinoma, SEER 13, 1992 – 2015. NOTE: An asterisk denotes the APC is statistically significantly different from zero (P <0.05) using a two-sided test.

Figure 2.

Annual percent change (APC) in age-specific incidence rates of hepatocellular carcinoma, SEER 13, 1992 – 2015. NOTE: An asterisk denotes the APC is statistically significantly different from zero (P <0.05) using a two-sided test. APC in 20-29 year age group could not be estimated because the standard error was available and/or number of cases too small. Y-axis scale varies across figures to demonstrate trend.

Figure 2.

Annual percent change (APC) in age-specific incidence rates of hepatocellular carcinoma, SEER 13, 1992 – 2015. NOTE: An asterisk denotes the APC is statistically significantly different from zero (P <0.05) using a two-sided test. APC in 20-29 year age group could not be estimated because the standard error was available and/or number of cases too small. Y-axis scale varies across figures to demonstrate trend.

Figure 2.

Annual percent change (APC) in age-specific incidence rates of hepatocellular carcinoma, SEER 13, 1992 – 2015. NOTE: An asterisk denotes the APC is statistically significantly different from zero (P <0.05) using a two-sided test. APC in 20-29 year age group could not be estimated because the standard error was available and/or number of cases too small. Y-axis scale varies across figures to demonstrate trend.

Figure 2.

Annual percent change (APC) in age-specific incidence rates of hepatocellular carcinoma, SEER 13, 1992 – 2015. NOTE: An asterisk denotes the APC is statistically significantly different from zero (P <0.05) using a two-sided test. APC in 20-29 year age group could not be estimated because the standard error was available and/or number of cases too small. Y-axis scale varies across figures to demonstrate trend.

Figure 2.

Annual percent change (APC) in age-specific incidence rates of hepatocellular carcinoma, SEER 13, 1992 – 2015. NOTE: An asterisk denotes the APC is statistically significantly different from zero (P <0.05) using a two-sided test. APC in 20-29 year age group could not be estimated because the standard error was available and/or number of cases too small. Y-axis scale varies across figures to demonstrate trend.

Figure 2.

Annual percent change (APC) in age-specific incidence rates of hepatocellular carcinoma, SEER 13, 1992 – 2015. NOTE: An asterisk denotes the APC is statistically significantly different from zero (P <0.05) using a two-sided test. APC in 20-29 year age group could not be estimated because the standard error was available and/or number of cases too small. Y-axis scale varies across figures to demonstrate trend.