Abstract PR1: Hepatocellular carcinoma research and prevention in South Texas: The imperative
Authors: Ramirez Amelie G. , Weiss Nancy S. , Holden Alan E. , Suarez Lucina , Cooper Sharon P. , Munoz Edgar , Naylor Susan L. 
Published: June 2012

Abstract
Introduction: Hepatocellular carcinoma (HCC) incidence is increasing in the U.S. for unknown reasons despite a decline in cancer overall during 1975–2006. Latinos have higher rates of HCC than other groups, and attributable risks for HCC among Latinos have been identified. This study compared HCC incidence and behavioral risk factors associated with it from 1995 through 2006 between U.S. Latinos, Texas Latinos and a South Texas Latino subset. We hypothesized that HCC incidence is higher among South Texas Latinos in conjunction with higher attributable behavioral risk factors during the same period.
Methods: Data from the U.S. SEER (Surveillance, Epidemiology, and End Results) Program, Texas Cancer Registry, and the Texas Department of State Health Services (TDSHS) were obtained. Annual age-specific and age-adjusted HCC incidence rates, annual percent changes (APCs) and 95% confidence intervals (CI) were calculated as well as prevalences of obesity, diabetes, heavy alcohol use and smoking. Analyses were performed using SEER*Stat and SPSS Complex Samples software. Groups were compared using Chi-Squared and T-Tests with differences assessed at p &lt; .05 if confidence intervals did not overlap.
Results: Latinos accounted for more than a third of HCC in Texas and nearly three-fourths of all HCC in South Texas, significantly greater proportions than SEER. More than 70% of HCC in Latinos occurred in men, with similar percentages observed among SEER, Texas and South Texas groups. HCC in Latinos was highest in South Texas (10.6/100,000) and Texas (9.7/100,000) compared to SEER (7.5/100,000). South Texas Latinos were older than their SEER counterparts (Median = 67 vs. 62). More South Texas and Texas Latinos than SEER resided in rural areas (14.8%, 14.3% vs. 5.2%). Prevalence percentages of HCC-related behavioral risk factors for Latinos in the U.S., Texas and South Texas for two time periods, 1995–1997 and 2004–2006 show that obesity increased among all three groups of Latinos overall from the first to the second time period. Additionally, Texas and South Texas Latinos had higher obesity prevalence than U.S. Latinos during the most recent period (30.2% and 35.0% versus 26.7%). Moreover diabetes prevalence increased among U.S. Latinos. Texas and South Texas Latinos also showed an increasing pattern, although confidence intervals overlapped. For 2004–2006, the prevalence of diabetes was higher in South Texas Latinas than U.S. Latinas (10.3% and 7.8%, respectively). Heavy alcohol and cigarette use did not change significantly over time among any Latino group.
Conclusion: Our findings support observations that HCC is alarmingly on the rise in the United States. We have described an important constellation of risks for HCC in this group that may result in higher rates of the disease among Latinos. Most if not all of these risks are modifiable, preventable or treatable. Clearly there is a need to focus on HCC etiological research and intervention that takes into account not only the most significant attributable risks for the disease, but also genetic, cultural and socioeconomic predisposing features. The potential contribution of these to HCC indicates a need for etiologic research to firmly establish associations and inform HCC-related prevention interventions.
Acknowledgements: This research was possible by grants from the San Antonio Cancer Institute, San Antonio, Texas (P30-CA54174) and the National Cancer Institute, Redes En Acción (U01-CA86117).
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):PR1.