Hepatocellular carcinoma and the Newcastle-upon-Tyne area
Authors: Alain Braillon
Journal: Journal of Hepatology (2014)

Hepatocellular cancer: The impact of obesity, type 2 diabetes and a multidisciplinary teamJournal of HepatologyVol. 60Issue 1PreviewHepatocellular cancer (HCC) commonly complicates chronic liver disease and increases in incidence have been reported despite falling prevalences of viral hepatitis. Full-Text PDF Reply to "Hepatocellular carcinoma and the Newcastle-upon-Tyne area"Journal of HepatologyVol. 60Issue 6PreviewWe thank Dr Braillon for drawing attention to our recent study describing the increase in hepatocellular cancer (HCC) related mortality in the decade following the introduction of the National Health Service 'Cancer Plan 2000'. Firstly, the reported increase in mortality was based on factual data for our region, provided by Public Health Englands' North of England Cancer Networks Knowledge and Intelligence team (Northern and Yorkshire) (NYCRIS) ( http://www.nycris.nhs.uk ). This region is defined by the North East of England, Cumbria, and North Yorkshire and has a stable population of approximately 3 million. Full-Text PDF Open Access The cross sectional studies of hepatocellular carcinoma (HCC) in the Newcastle-upon-Tyne area may need further clarifications by the authors [[1]Dyson J. Jaques B. Chattopadyhay D. et al.Hepatocellular cancer: the impact of obesity, type 2 diabetes and a multidisciplinary team.J Hepatol. 2014; 60: 110-117Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar]. First, how can HCC-related mortality in this region have risen 1.8 fold in 10 years, from 2.0 to 3.7 per 100.000. Indeed, over the last decade (between 1999–2001 and 2008–2010), the UK age-standardised incidence rates have only increased by 45% and 29% in males and females, respectively. These rates are not different from those observed in Europe: 44% and 31% increases, respectively (http://www.cancerresearchuk.org/cancer-info/cancerstats/types/liver/incidence/). Why could the significant progresses made for early diagnosis and in treatments (e.g., sorafenib, RFA) have lacked effect on mortality? Second, why are Dyson et al. not concerned with smoking? Smoking prevalence (April 2010–March 2011) is 23.8% in the Newcastle-upon-Tyne area and therefore higher than in England (20.7%) (http://www.newcastle.gov.uk/sites/drupalncc.newcastle.gov.uk/files/wwwfileroot/business/trading_standards/occasional_paper_no_49__smoking_prevalence_in_the_north_east__final.pdf). It is an independent and a dose-related contributing factor for HCC, all over the world, even in Asia [[2]Jee S.H. Ohrr H. Sull J.W. Samet J.M. Cigarette smoking, alcohol drinking, hepatitis B, and risk for hepatocellular carcinoma in Korea.J Natl Cancer Inst. 2004; 96: 1851-1856Crossref PubMed Scopus (174) Google Scholar]! The mean relative risk is 1.5 but exposure is high [[3]Lee Y.C. Cohet C. Yang Y.C. Stayner L. Hashibe M. Straif K. Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer.Int J Epidemiol. 2009; 38: 1497-1511Crossref PubMed Scopus (170) Google Scholar]. In France, tobacco, viral hepatitis, and alcohol are the 3 main risk factors for HCC contributing with 33%, 31%, and 26%, respectively to HCC [[4]Hill C, Doyon F, Mousannif A. Évolution de la mortalité par cancer en France de 1950 à 2006. Institut de Veille Sanitaire. p75. Accessed 10 January 2013, at http://www.invs.sante.fr/display/?doc=publications/2009/evolution_mortalite_cancer_france_1950_2006/index.html.Google Scholar]. Last, the cause of non-alcoholic fatty liver disease is still unknown, it is only a syndrome. Both obesity and insulin resistance may play a role in the process. However, (a) liver disease per se produces insulin resistance; (b) morbid obesity does not appear to be a cause of liver disease in large series when other known causes are carefully investigated [[5]Braillon A. Capron J.P. Hervé M.A. Degott C. Quenum C. Liver in obesity.Gut. 1985; 26: 133-139Crossref PubMed Scopus (122) Google Scholar]. Did Dyson et al., questioned the entourage for alcohol consumption and how they recorded past history of medicine prescriptions, such as antidepressants [6Youssef N.A. Abdelmalek M.F. Binks M. et al.Associations of depression, anxiety and antidepressants with histological severity of nonalcoholic fatty liver disease.Liver Int. 2013; 33: 1062-1070Crossref PubMed Scopus (108) Google Scholar, 7Park S.H. Ishino R. Liver injury associated with antidepressants.Curr Drug Saf. 2013; 8: 207-223Crossref PubMed Scopus (38) Google Scholar]? The author declared that he does not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.