Trends in Incidence of Primary Liver Cancer in the Elderly (Aged 65+ Years) in England, 1971-2010

Background: About 45% of the cases of liver cancer in England are diagnosed in the elderly. Since the 1990s, there has been a substantial increase in the incidence of liver cancer, and it has been projected that the incidence of rates will continue to increase to 15/100,000 by 2035. Aim: To determine the trends of incidence of liver cancer in the elderly in England during the period 1971-2010. Methods: Population-based national cancer registration data (obtained from the Office for National Statistics) were analyzed to determine the incidence of liver cancer (ICD-9 code: 155, ICD-10 code: C22) by age, gender, morphologic subtype and level of deprivation. Microsoft Excel and SPSS software were used for the analysis. Results: During the 40-year period, a total of 42,800 cases of liver cancer in the elderly were registered in England (58% male, 42% female). The number of cases increased by 462% - from 2,019 in 1971-75 (404 cases/year) to 11,345 in 2006-10 (2269 cases/year). The incidence rate (per 100,000) increased from 9.0 in 1971-75 to 37.4 in 2006-10 in males (316% increase); and from 4.6 to 19.6 in females (326% increase). In males, the incidence rates of liver cell carcinoma (ICD-10 code: C22.0) increased by 140% and the intrahepatic bile duct carcinoma (ICD-10 code: C22.1) by 2467%; whereas in females the incidence rates increased by 22% and 2260%, respectively. As for level of deprivation, the largest increase in incidence was observed in the least deprived population (721% in males, 690% in females). Conclusion: During the past four decades, there has been a remarkable increase in the incidence of liver cancer in the elderly in England. The relatively large increase in liver cell carcinoma in males, those in the least deprived category, and substantial increase in intrahepatic bile duct carcinoma in both genders warrant further investigation. These findings are also relevant for the planning of oncology services, resource allocation, screening for early diagnosis and public health education for primary prevention of liver cancer.