Although their forecasting of incidence rates was performed by race/ethnicity, birth cohort effects were not examined by race/ethnicity, and the study focused on the entire US data. ( 5) projected liver cancer incidence rates by race/ethnicity for the entire United States using age-period-cohort (APC) forecasting models and data from the Surveillance, Epidemiology, and End Results Program (SEER) for the years 2000 to 2012. With the changing demographic and trends of HCC incidence, there is a need to plan better prevention strategies for HCC.Īlthough the rising trend of HCC in the United States has been well established ( 5, 16–18), few studies have examined the dynamically changing trends of California or projected the expected numbers of new HCC cases in the United States or California. The numbers of these two minority groups are rapidly increasing, shaping a different demography in the United States ( 14, 15). Recent study showed that California is among the top 10 states with the highest overall mortality for both liver cancer and chronic liver disease ( 16). Approximately one-third of Asians and over one-fourth of Hispanics in the United States live in California, which has the nation’s largest population (with close to 40 million individuals and 12% of the US population) ( 14, 15). In the United States, Asian and Hispanic populations have the highest incidence of HCC, with rates two- to threefold higher compared with whites ( 13, 14). HCC incidence also varies substantially by geography the rate is high in Southeast Asia and sub-Saharan Africa and low in South and Central America and Europe ( 11, 12). Other important risk factors for HCC include excessive alcohol consumption, aflatoxin, obesity, diabetes, and nonalcoholic fatty liver disease ( 7). The incidence rate of HCC varies by sex, with males experiencing two to four times higher incidence than females ( 7), and it also varies by age, with the peak incidence observed in individuals ages 75 years and older ( 10). The major risk factors for HCC include chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV) ( 3, 6–9). As of 2013, the incidence of HCC is 22.2 per 100 000 person-years in males and 5.7 per 100 000 person-years in females among individuals aged 35 to 84 years ( 5). The incidence of hepatocellular carcinoma (HCC), the predominant form (>80%) of liver cancer, has tripled in the United States during the past three decades ( 2–4). Liver cancer is the second leading cause of cancer deaths worldwide ( 1).
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