Introduction Increasing mortality rates for some types of primary liver cancer have been documented in several countries in recent years. The figures published for England and Wales have described a marked increase in cases of intrahepatic cholangiocarcinoma with a static or declining rate of mortality from hepatocellular carcinoma (HCC).1 However, over the last decade, the prevalence of several risk factors for HCC (chronic viral hepatitis, alcoholic liver disease and obesity/NASH) have all dramatically increased in Wales. We therefore hypothesised that, due to the significant difference in population size between these two regions, a dilutional effect may have masked the true incidence of HCC within Wales.
Methods The database of the Welsh Cancer Intelligence and Surveillance Unit was examined for all liver tumour types affecting Welsh residents regardless of treatment location across the years 1999–2008 inclusive. The incidence was recorded as the European Age Standardised Rate (EASR) per 100 000 population. Subcategory analysis was made for hepatocellular carcinoma, fibrolamellar HCC, combined HCC and cholangiocarcinoma and all liver malignant neoplasms. Patients were stratified according to age and sex and an additional 3 years moving-average EASR calculated across the whole study period.
Results There was a significant and progressive increase in the incidence of HCC in Wales from 1999 to 2008. The absolute numbers of HCC cases, the EASR and the proportion of malignant liver neoplasms have all risen. In men, the EASR increased by 100% in just 8 years from 1.9 to 3.8 per 100 000. In addition, the EASR increased in women by 83% from 0.6 to 1.1 per 100 000. The rolling 3-year average rates closely followed these trends throughout the 10-year study period. Notably, in both sexes there has been a substantial rise in the number of HCC cases in patients under the age of 70 years.
Conclusion In contrast to the previously published trends, we found the incidence of hepatocellular carcinoma has consistently increased over the last decade in Wales. This rise may reflect regional changes in HCC risk factors and may have been obscured by combining figures with the much larger population of England. Further research will be necessary to determine the underlying causes of this increase and to direct resources toward the prevention and early detection of HCC in Wales.
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