Hepatocellular carcinoma – the most common type of primary liver cancer – is the fifth most common cancer in men and the ninth most common in women worldwide. In 2012 there were approximately 782,000 new cases worldwide.
Liver cancer is the second most common cause of death from cancer worldwide, with an estimated 746,000 deaths in 2012. This is in part due to its high mortality/incidence ratio (0.95). The Global Burden of Disease study reported that in 2010 there were approximately 752,000 deaths due to liver cancer globally. While the number of liver cancer deaths increased by 62% from 1990 to 2010 (from 463,000), the age-standardised incidence rate increased by only 2%.
Around 83% of cases worldwide occur in less developed regions. Regions with high incidence include eastern and south-eastern Asia, northern and western Africa, and Melanesia and Micronesia/Polynesia (particularly in men). Rates are comparatively low in developed areas with the exception of southern Europe, where incidence in men is significantly higher than in other developed countries.
This geographical variation in the incidence of hepatocellular carcinoma is largely explained by the prevalence of the major risk factors - hepatitis C virus (HCV) and hepatitis B virus (HBV) infection - as explored in the Causes section of this chapter.
Liver cancer in Australia
Liver cancer incidence is relatively low in Australia compared with other regions of the world but is growing faster than that of any other cancer in Australia. Liver cancer is rarely detected early and as a consequence has a high mortality rate.
In Australia in 2014, 1,961 people were diagnosed with primary liver cancer. Hepatocellular carcinoma accounted for the majority of liver cancer cases, but Australian classifications of liver cancer include other tumours such as cholangiocarcinoma, hepatoblastoma and tumours without histological confirmation. Liver cancer caused 1,961 deaths (4% of cancer deaths) in Australia in 2014, elevating it to the top 10 causes of cancer deaths.
In Australia, age-standardised liver cancer incidence rates are highest in some overseas-born populations, particularly those from countries where HBV and HCV are endemic. Analysis of incidence in NSW shows liver cancer rates are higher in geographic areas that have a large overseas-born population, especially immigrants from southeastern and eastern Asia and middle and western Africa.
Compared with the non-Indigenous population, Indigenous Australians have a five to 10 times higher population-based incidence rate of hepatocellular carcinoma and are 12 times more likely to die of liver cancer. This reflects a higher burden of chronic liver disease in Australian Aboriginal populations, including high rates of chronic HBV infection.
While liver cancer is relatively uncommon in Australia, age-standardised rates have been steadily increasing over the past three decades. Incidence has increased from 1.8 cases per 100,000 people in 1982 to 7.4 cases per 100,000 in 2013.
Age-standardised liver cancer incidence – particularly hepatitis B related liver cancer – is expected to continue to rise over the next two decades. Incidence in Australia is projected to almost double by 2020, from 1,304 cases in 2008 to 2,465 in 2020. This continuing rise is attributed to a large number of asymptomatic people with chronic viral hepatitis, immigration from countries where hepatitis infection is prevalent and the slow disease progression from chronic hepatitis infection to liver cancer.
There is little data on the direct economic cost of liver cancer in Australia. Studies on the costs associated with HBV and HCV are generally not able to be compared due to different methodologies used, costs included and data sources. As such, the figures below for the economic costs associated with HBV and HCV in Australia are not comparable as study methodologies and inclusions differ.
In 2009-2010, Government spending on HBV and HCV agents through the Pharmaceutical Benefits Scheme amounted to almost $88 million. This figure represents Government spending on ten hepatitis drugs and does not include the patient co-payment portion for the included drugs.
In 2008, the direct costs of managing and treating people with HBV infection in Australia were estimated at $171.8 million. The direct costs of managing a patient with HBV includes all medical, hospital and allied health service and support service costs. Based on projections for chronic HBV infection, this evaluation estimated that the direct costs, under current practices, would increase to $308 million in 2017, representing an 80% increase. The average cost of managing each patient with chronic HBV infection and hepatocellular carcinoma was estimated at nearly $14,000 (without therapy) to about $19,000 (with therapy) .
In 2004-05 the estimated costs associated with HCV, including research, prevention, care and treatment, was $156 million. The cost of diagnosing and treating people with chronic HCV in 2004-05 was estimated at approximately $78.9 million, including all medical, hospital, laboratory and pharmaceutical costs. The average cost of treatment of each person with hepatitis C related hepatocellular carcinoma was estimated at $118,146.
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