Gastroenterology

Gastroenterology

Volume 152, Issue 4, March 2017, Pages 812-820.e5
Gastroenterology

Original Research
Full Report: Clinical—Alimentary Tract
Incidence of Hepatocellular Carcinoma in All 50 United States, From 2000 Through 2012

https://doi.org/10.1053/j.gastro.2016.11.020Get rights and content

Background & Aims

The incidence and mortality of hepatocellular carcinoma (HCC) have been reported to be plateauing in the United States. The United States has large racial, ethnic, and regional variation; we collected data from all 50 states to better analyze changes in HCC incidence in the entire United States.

Methods

We collected data from the US Cancer Statistics registry, which covers 97% of the population, and calculated adjusted incidence rates. We assessed annual trends among sociodemographic and geographic subgroups using joinpoint analysis.

Results

HCC incidence increased from 4.4/100,000 in 2000 to 6.7/100,000 in 2012, increasing by 4.5% (95% confidence interval [CI], 4.3%–4.7%) annually between 2000 and 2009, but only by 0.7% annually (95% CI, –0.2% to 1.6%) from 2010 through 2012. The average annual percentage change (AAPC) between 2000 and 2012 was higher in men (increase, 3.7%) than in women (increase, 2.7%), and highest in 55- to 59-year-old individuals (AAPC, 8.9%; 95% CI, 7.1%–10.7%) and 60- to 64-year-old individuals (AAPC, 6.4%; 95% CI, 4.7%–8.2%). By 2012, rates in Hispanics surpassed those in Asians, and rates in Texas surpassed those in Hawaii (9.71/100,000 vs 9.68/100,000). Geographic variation within individual race and ethnic groups was observed, but rates were highest in all major race and ethnic groups in Texas.

Conclusions

In an analysis of the incidence of HCC in all 50 US states, we found the rate of increase in HCC to have slowed from 2010 through 2012. However, incidence is increasing in subgroups such as men ages 55 to 64 years old—especially those born in the peak era of hepatitis C virus infection and among whites/Caucasians. Rates in Hispanics have surpassed those in Asian Americans. We observed geographic differences, with Texas having the highest age-adjusted HCC rates nationwide.

Section snippets

Materials and Methods

We obtained HCC incidence data from the United States Cancer Statistics (USCS) registry. The USCS registry is the official data source for federal government–reported cancer incidence statistics. It compiles data on all incident cancer cases reported in 2 primary sources, the Center for Disease Control and Prevention’s National Program of Cancer Registries, which includes all population-based state cancer registries, and the SEER program, which includes 14 population-based cancer registries and

Results

There were 236,290 HCC cases diagnosed between 2000 and 2012 in the USCS registry (Table 1). In 2012 alone there were 24,696 new HCC cases, representing a 115% increase in the absolute numbers of cases reported in 2000 (n = 11,469). The age-adjusted incidence rate for HCC increased from 4.4/100,000 (95% CI, 4.3–4.5) in 2000 to 6.7/100,000 (95% CI, 6.6–6.8) in 2012, representing an AAPC of 3.5% (95% CI, 3.3%–3.8%; P < .001). Joinpoint regression identified 1 significant cut-off point (2009) and

Discussion

In the population-based data representing all 50 US states, we found that the overall age-adjusted incidence rates for HCC increased between 2000 and 2012 from 4.4/100,000 to 6.7/100,000. Most of the increase in incidence rates occurred by 2009, with a significant 4.5% average APC between 2000 and 2009, followed by a lower nonsignificant average change of 0.7% per year between 2010 and 2012. The small increases in annual age-adjusted incidence rates since 2010 (from 6.5, 6.6, and 6.7/100,000 in

Acknowledgment

Donna White, Jessica Davila, and Hashem El-Serag were responsible for research inception; Donna White, Hashem El-Serag, and Aaron Thrift performed the analysis; Donna White, Aaron Thrift, Fasiha Kanwal, and Hashem El-Serag were responsible for the interpretation of results; Donna White, Aaron Thrift, and Hashem El-Serag wrote the manuscript; and Donna White, Jessica Davila, Fasiha Kanwal, Aaron Thrift, and Hashem El-Serag were responsible for the critical review of the manuscript.

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    Conflicts of interest The authors disclose no conflicts.

    Funding This research was supported in part by the Cancer Prevention and Research Institute of Texas (RP150587), the National Cancer Institute (CA190776 and CA125123), the National Diabetes Digestive and Kidney Disease Institute (DK 56338, DK078154A, and DK095082), and the Houston Department of Veterans Affairs Health Services Research & Development Center of Innovations (CIN13-413). The National Institutes of Diabetes Digestive and Kidney Diseases, National Cancer Institute, the US Department of Veterans Affairs, and the Cancer Prevention Research Institute of Texas played no role in the design, analysis, interpretation, or publication of these results.

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