The Report to the Nation on the Status of Cancer (1975-2012) shows that death rates continued to decline for all cancers combined, as well as for most cancer sites for men and women of all major racial and ethnic populations. The overall cancer death rates for both sexes combined decreased by 1.5 percent per year from 2003 to 2012. Incidence rates—new cancer cases that are diagnosed per 100,000 people in the U.S.—decreased among men and remained stable for women between 2003 and 2012.
The ongoing drop in cancer incidence in most racial and ethnic groups is due, in large part, to progress in prevention and early detection. Fewer deaths from cancer in those same groups may also reflect better treatments. Tobacco control efforts have contributed to lower rates of lung cancer, the leading cause of cancer death in both men and women, as well as many other types of cancer.
The report also examines trends in liver cancer. In contrast to the trends for most other cancers among both men and women, death rates due to liver cancer have increased the most compared with all cancer sites, and liver cancer incidence rates have also increased sharply.
“The latest data show many cancer prevention programs are working and saving lives,” said CDC Director Tom Frieden, MD, MPH. “But the growing burden of liver cancer is troublesome. We need to do more work promoting hepatitis testing, treatment, and vaccination.”
Key findings on liver cancer:
- From 2008 to 2012, liver cancer incidence increased an average of 2.3 percent per year overall, and the liver cancer-related death rate increased by an average of 2.8 percent per year among men and 3.4 percent per year among women.
- In all racial and ethnic populations, about twice as many men as women were diagnosed with liver cancer.
- Between 2008 and 2012, liver cancer incidence rates were highest among non-Hispanic American Indian/Alaska Native men followed by non-Hispanic Asian/Pacific Islander men.
- Hepatitis C and liver cancer-associated death rates were highest among those born in 1945-1965; these also represent the majority of Americans with hepatitis C infection.
“Research over the past decades has led to the development of several vaccines that, given at the appropriate ages, can reduce the risk of some cancers, including liver cancer,” said Douglas Lowy, M.D., acting director of the National Cancer Institute. “Determining which cancers can be effectively prevented by vaccines and other methods is one of our top priorities at NCI and one which we believe will truly make a difference in cancer incidence and mortality trends.”
The authors noted that, in the United States, a major contributing factor to liver cancer is hepatitis C virus (HCV) infection. A little more than 20 percent of the most common liver cancers are attributed to HCV infection. Compared with other adults, people born during 1945-1965 have a six times greater risk of HCV infection. CDC recommends all people born during 1945-1965 receive a one-time test for HCV. Diagnosis of HCV, followed by treatment, can greatly reduce the risk of liver cancer.
“We have the knowledge and tools available to slow the epidemic of liver cancer in the U.S., including testing and treatment for HCV, hepatitis B vaccination, and lowering obesity rates,” said Otis W. Brawley, M.D., chief medical officer of the American Cancer Society. “We hope that this report will help focus needed attention and resources on liver cancer.”
Hepatitis B virus (HBV) infection also increases the risk for liver cancer. HBV is a common risk factor for liver cancer for Asian/Pacific Islander populations, especially among Asians not born in the United States, and CDC recommends universal HBV testing for this population. Fortunately, rates of HBV infection are declining worldwide due to increases in hepatitis B vaccination of children beginning at birth.
Obesity and type 2 diabetes can cause cirrhosis, or scarring of the liver, which can progress to liver cancer and is associated with excessive alcohol use; from 8 to 16 percent of liver cancer deaths are attributed to excessive alcohol use.
“Collecting and analyzing high-quality cancer surveillance data is essential for tracking the benefits of screening and other prevention efforts,” said Betsy Kohler, executive director, North American Association of Central Cancer Registries. “Data from an estimated 97 percent of all newly diagnosed cancer cases in the US are used in this report.”
The Report to the Nation is released each year in a collaborative effort by the American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries.
To view the full Report, go to http://onlinelibrary.wiley.com/doi/10.1002/cncr.29936/full
Statement from John W. Ward, M.D. Director of CDC’s Division of Viral Hepatitis
The nation’s annual report on cancer, released today, shows that while we are making substantial progress against cancer overall, a rapidly increasing number of Americans are developing and dying from liver cancer, despite the fact that viral hepatitis – a primary cause of liver cancer – is preventable and treatable.
We have the tools we need to reverse this alarming trend – vaccination for hepatitis B, and testing and treatment for hepatitis B and C. But we urgently need to do more to ensure that these tools are available to and used by everyone who needs them.
CDC recommends that all newborns should be vaccinated against hepatitis B as part of the standard infant vaccine schedule. However, only 70 percent of newborns are currently being vaccinated. Adults who never received the hepatitis B vaccine as a child should also be vaccinated.
For those who become infected with hepatitis B or C, testing, diagnosis and treatment can dramatically decrease the risk of developing liver cancer. Antiviral medications can reduce liver cancer risk by up to 80 percent in people living with hepatitis B, but fewer than 15 percent of treatment-eligible individuals are currently prescribed them.
Treatment for hepatitis C is equally effective at reducing the risk of liver cancer. Most hepatitis C infections can be cured in just two to three months, reducing liver cancer risk by 75 percent. However, at least half of the 3.5 million people living with hepatitis C in the United States do not know they are infected.
Like hepatitis B, hepatitis C infection initially has few noticeable symptoms – meaning it can slowly and silently damage the liver for years, even decades, causing progressive scarring, cirrhosis, and liver cancer.
The vast majority of people living with this silent killer are baby boomers, born from 1945 to 1965. They were unknowingly infected before hepatitis C was discovered in 1989 and are at greatest risk for and experiencing the greatest increases in liver cancer. Testing those born from 1945 to 1965 and referring infected individuals to care and treatment can prevent more than 320,000 deaths.
Rates of new hepatitis C infections have also increased in many parts of the country in recent years among young people who inject drugs, adding a new generation to those already struggling with this infection.
For these young people and the millions of other Americans living with hepatitis B and C, we must act now. Today’s report shows that liver cancer is one of the few areas where our nation is losing the battle against cancer – but it doesn’t have to be this way. Focused efforts to vaccinate, diagnose and treat viral hepatitis can drive back liver cancer and prevent other deadly consequences of these infections, saving hundreds of thousands of lives.