Trends in mortality from primary liver cancer in Europe

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Abstract

Upward trends in incidence and mortality from primary liver cancer have been reported from Japan, the USA and a few European countries. Thus, we systematically reviewed trends in age-standardised death certification rates from primary liver cancer between 1970 and 1996 in 20 European countries providing data for the World Health Organisation database. Overall age-standardised (world population) mortality rates were approximately stable or showed no consistent trends in seven countries, including Bulgaria and Hungary (with exceedingly high rates), Finland, The Netherlands and the UK. Moderate rises were observed in Austria, Germany and Switzerland, and much larger upward trends in France and Italy, particularly for males. Downward trends were observed in both sexes in Belgium, Spain, Ireland, Greece and several Scandinavian countries. The per cent change in rates per year ranged, for males, from −7.4% for Ireland and −5.1% for Spain to +4.4% for Italy and +8.6% for France. Trends were more favourable in women, with 15 out of 20 countries showing downward trends in rates, and moderately more favourable in middle age (45–64 years) and, in major European countries, in young adults (20–44 years of age). In conclusion, trends in liver cancer mortality in Europe are heterogeneous. The fall in mortality in countries like Spain may be largely explained by improvements in the distinction between primary and secondary liver neoplasms, whereas upward trends in Central Europe and Italy are likely to be, at least in part, real. Increases in infection with the hepatitis C virus, and improved and increased searches for liver cancer in cirrhotic patients are two of the likeliest explanations for these observations.

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.

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