Epidemiology of Hepatocellular Carcinoma in Florida – Part I: A Statewide Report

The increasing incidence of hepatocellular carcinoma (HCC) has become a burgeoning public health problem. The effect has been most notable at liver transplant centers. Traditional reports of liver cancer include many non-HCC variants. This study aims at determining the incidence of HCC in the state of Florida, utilizing data from Florida Cancer Data Systems. This study pertains exclusively to HCC. Of 2,296,794 cancer cases, 4,447 HCC and variants were identified (68.7%). Incidence rates were as follows. The incidence of HCC in the state of Florida was 6.1 cases /100,000 population/year; Male: 9.6/100,000 population/year vs. Female: 2.7; Whites: 6.5/100,000 population/year vs. Blacks: 5.3; Hispanics: 4.6/100,000 population/year vs. Non-Hispanics: 6.5. Limitations of the study included lack of etiology of liver disease, treatments and survival. The classification of tumors and under-reporting in the database are also concerns. The study elaborates on guidelines for screening and diagnosis of HCC. The incidence of HCC in Florida in this study was three times higher than previous reports from 2 decades ago. This is the most updated study reporting the incidence of HCC in Florida, although data was 5 years old. The incidence of this cancer is expected to continue to increase over the next decade. The study is a preamble to socioeconomic and county studies currently being performed at this liver transplant center. Florida Public Health Review, 2012; 9, 18-23. Background Hepatocellular carcinoma (HCC), a primary malignancy of the liver and one of the most common malignancies worldwide accounts for more than 1 million deaths annually. The increasing incidence of HCC has started to become a burgeoning public health problem. Recent publications during the past 40 years have noted a significant rise in the incidence of HCC within the United States (Altekruse, McGlynn, & Reichman, 2009). The geographic distribution of HCC has been linked to a multitude of risk factors: Hepatitis B virus and Hepatitis C virus being the two most implicated factors. It has been shown that the distribution of HCC is closely related to the incidence of hepatitis B/C virus infection. Therefore, not surprisingly, because the high rates of horizontal transmission of hepatitis B, the highest incidences of HCC are found in Southeast Asia and Africa (greater than 10 to 20 per 100,000), whilst the lowest incidence is found in Australia, North America and Europe (1-3 per 100,000). HCC has been demonstrated to be the third leading cause of cancer mortality worldwide (Altekruse et al., 2009). It has also been shown that approximately 90% of primary liver carcinomas within the United States are HCC, while the remaining 10 percent are cholangiocarcinomas. It has been established throughout literature that a large percent of HCC is significantly associated with hepatitis viral infection, while other factors include alcohol use, smoking, genetic metabolic disease, cirrhosis, environmental exposure, chronic infections and family history of liver cancer. Over the past 20 years, the age adjusted incidence of HCC has nearly tripled in the United States, ignited by the unforeseen incidence of chronic Hepatitis C and Hepatitis B. At present there are 4 million US citizens afflicted with chronic Hepatitis C and 1.2 million afflicted with chronic hepatitis B. Like the rest of the U.S., the incidence of liver cancer has increased significantly within the state of Florida. Whether the increased incidence is related to immigration, increased screening, increased rate of hepatitis B or hepatitis C infection, cirrhosis, obesity/diabetes mellitus or a combination has yet to be determined. HCC is the fastest growing cause of cancer-related deaths in the U.S. (National Cancer Institute [NCI], 2006) and has the highest mortality in the obese population (Calle, Rodriguez, Thun & Walker-Thurmond 2003). Previous reports of liver cancer in Florida come from two recent sources. In 2001, from the Department of Epidemiology and Public Health, the overall incidence between 1985 and 1995 was 2.01/100,000 population; 3.29/100,000 in Hispanics; 1.82/100,000 in white males; 3.86/100,000 in Black males; 1.23/100,000 and 1.18/100,000 in Hispanic and Black females, respectively; and 0.6/100,000 in White females (Shea, Fleming, Wilkinson, WohlerTorres, & McKinnon, 2001). The second study was from the Bureau of Epidemiology, Florida Department of Health (DOH) (Florida Department of Health: Bureau of Epidemiology [DOHBOE],