Liver cancer in the elderly

The incidence of hepatocellular carcinoma is increasing in the United States, and the increase is expected to continue until the rate of the major cause--infection with hepatitis B or C-is brought under control.

The incidence of hepatocellular carcinoma increased by 71% from 1976 to 1995, according to figures published last week by researchers at the Veterans Affairs Medical Center in Albuquerque, New Mexico (Nat, England Journal of Medicine 1999;340:745-50).

Researchers found that the incidence increased from 1.4/100 000 population between 1976 and 1980 to 2.4/100 000 between 1991 and 1995.

Black men were more than twice as likely to contract the disease as their white counterparts, with 6.1 cases reported per 100 000 black men; there were 2.8 cases per 100 000 among white men.

In developed countries hepatocellular carcinoma has previously occurred at high rates in elderly people. However, the authors adjusted the rates for age and found that the ageing of the population did not explain the rising rates of cancer. They found a shift in the incidence of hepatocellular carcinoma towards younger age groups.

The three main risk factors associated with hepatocellular carcinoma are infection with hepatitis B or C virus and alcoholic cirrhosis. The incidence of alcohol related cirrhosis is declining so infection with hepatitis B and C viruses is thought to be the main cause behind the increase in associated cancers. Many older Americans with hepatitis C are believed to have contracted it from blood transfusions received before the blood supply was as carefully screened.