Trends in mortality from primary liver cancer in Europe
Introduction
Upward trends in incidence and mortality from hepatocellular carcinoma over the last two decades have been reported from Japan [1], the UK 2, 3, France [4] and the USA [5]. These rises were observed in men and women, in blacks and whites in the USA, in younger and elderly populations, suggesting that they cannot be accounted for totally by increased diagnosis and certification of the disease. It has also been suggested that the increased prevalence of hepatitis C viruses (HCV) may, at least in part, explain these upward trends 6, 7.
Liver cancer incidence and, even more, mortality rates have to be interpreted with the utmost caution, due to the substantial problems of reliability and validity of certification data for liver cancer 8, 9, 10, most notably the difficulty of distinguishing accurately primary from secondary liver cancers.
With these cautions in mind, we have systematically reviewed the data from death certificates for primary liver cancer between 1970 and 1996 in 20 major European countries providing data for the World Health Organisation (WHO) database.
Section snippets
Patients and methods
The numbers of deaths certified from primary liver cancer over the period 1970–1996 were abstracted for 20 European countries from the WHO database. All classifications used were re-coded according to the Ninth Revision of the International Classification of Diseases (ICD-9 code 155.0; [11]). Estimates of the resident populations, based on official censuses, were obtained from the same WHO database. In order to assess the extent to which different practices of death certification over time may
Results
Fig. 1 gives the trends in age-standardised (at all ages and truncated from 35 to 64 years; world standard population) mortality rates from primary liver cancer in 20 major European countries from 1970 to 1996, using three different scales (5, 10 and 20/100 000). Rates were approximately stable or showed no consistent trend in seven countries, including Bulgaria and Hungary, Finland, The Netherlands and the UK. Moderate rises, particularly in more recent calendar periods, were observed in
Discussion
The present analysis confirms the existence of substantial variations in mortality rates from primary liver cancer across Europe (from below 1 in Norway and Ireland to above 6 per 100 0000 males in Bulgaria, Hungary, Italy and France [12]). Inconsistent patterns also emerged for mortality trends. The pattern of trends was also diverging in the two sexes, since liver cancer mortality tended to increase in males, but to decline in females in most countries of the European Union.
With respect to
Acknowledgements
Supported by the Swiss League against Cancer and the Italian Association for Cancer Research.
References (31)
- et al.
Increase in primary liver cancer in the UK, 1979–94
Lancet.
(1997) - et al.
Trends in primary liver cancer
Lancet.
(1998) - et al.
Cancer mortality in Europe, 1990–1994, and an overview of trends from 1955 to 1994
Eur. J. Cancer
(1999) - et al.
Worldwide patterns and trends in mortality from liver cirrhosis, 1955–90
Ann. Epidemiol.
(1994) Hepatocellular carcinoma
J. Hepatol.
(1992)- et al.
Hepatocellular carcinoma and hepatitis B virusa prospective study of 22,707 men in Taiwan
Lancet.
(1981) - et al.
Changing incidence of hepatocellular carcinoma in Japan
Cancer Res.
(1987) - et al.
Trends in primary liver cancer (letter)
Lancet.
(1998) - et al.
Rising incidence of hepatocellular carcinoma in the United States
N. Engl. J. Med.
(1999) - et al.
Hepatitis C virus and hepatocellular carcinoma
Eur. J. Cancer Prev.
(1996)
The increasing incidence of hepatocellular carcinoma
N. Engl. J. Med.
The causes of cancerquantitative estimates of avoidable risks of cancer in the United States today
J. Natl. Cancer Inst.
Trends in cancer mortality in Europe, 1955–1989: I. Digestive sites
Eur. J. Cancer
Cancer incidence and mortality in Europe
J. Epidemiol. Biostat.
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