Changing trends in liver cancer incidence by race/ethnicity and sex in the US: 1992–2016

Maxwell Salvatore, Jihyoun Jeon, Rafael Meza

Liver cancer incidence continues to increase while incidence of most other cancers is decreasing. We analyze recent and long-term trends of US liver cancer incidence by race/ethnicity and sex to best understand where to focus preventive efforts. Liver cancer incidence rates from 1992 to 2016 were obtained from the Surveillance, Epidemiology, and End Results registry. Delay-adjusted age-standardized incidence trends by race/ethnicity and sex were analyzed using joinpoint regression. Age-specific incidence was analyzed using age-period-cohort models. Hepatitis C seroprevalence by cohort was calculated using National Health and Nutrition Examination Survey data. Liver cancer incidence has peaked in males and Asian or Pacific Islanders. Hispanic males, a high-incidence population, are experiencing a decrease in incidence, although not yet statistically significant. In contrast, incidence continues to increase in females, although at lower rates than in the 1990s, and American Indian/Alaska Natives (AI/ANs). Liver cancer incidence continues to be higher in males. Non-Hispanic Whites have the lowest incidence among racial/ethnic groups. Trends largely reflect differences in incidence by birth-cohort, which increased considerably, particularly in males, for those born around the 1950s, and continues to increase in females and AI/ANs. The patterns in males are likely driven by cohort variations in Hepatitis C infection. Liver cancer incidence appears to have peaked among males. However, important differences in liver cancer trends by race/ethnicity and sex remain, highlighting the need for monitoring trends across different groups. Preventive interventions should focus on existing liver cancer disparities, targeting AI/ANs, females, and high-incidence groups.