Liver cancer incidence statistics

Liver cancer is the 18th most common cancer in the UK (2009), accounting for 1% of all new cases of cancer.1-4 Liver cancer is the 15th most common cancer among men in the UK, accounting for more than 1% of all new cases of cancer in males. Among women in the UK, liver cancer is the 19th most common, accounting for around 1% of all new cases of cancer in females.

In 2009, there were 3,960 new cases of liver cancer in the UK (Table 1.1): 2,492 (63%) in males and 1,468 (37%) in females, giving a male:female ratio of around 17:10.1-4 The crude incidence rate shows that there are around 8 new liver cancer cases for every 100,000 male in the UK, and around 5 for every 100,000 females.

The European age-standardised incidence rate (AS rate) is significantly higher in Scotland than in England (males only) and is significantly lower in Northern Ireland than in England (females only) (Table 1.1).1-4 The rates do not differ significantly between Wales and the other countries of the UK in either sex.

Table 1.1: Liver Cancer (C22), Number of New Cases, Crude and European Age-Standardised (AS) Incidence Rates per 100,000 Population, UK, 2009

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*95% LCL and UCL are the 95% lower and upper confidence limits around the AS rate

There are no routinely available data on geographical variation of liver cancer incidence in regions of England. In Scotland, the highest rates are in Greater Glasgow & Clyde Health Board.5

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Liver cancer incidence is strongly related to age, with the highest incidence rates being in older men and women. In the UK between 2007 and 2009, an average of 70% of cases were diagnosed in men and women aged 65 years and over. More than nine in ten cases were diagnosed in men and women aged 50 and over (Figure 1.1).1-4 Age-specific incidence rates rise from around age 40, steadily for women and more steeply for men, reaching an overall peak in the 80+ age group. 

Incidence rates are higher for males than for females, except for the under-15 age groups, when rates are similar between the sexes, or slightly higher in females. The gap between the male and female rates is highest between the ages of 55 and 59 when the male:female incidence ratio of age-specific rates (to account for the different proportions of males to females in each age group) is around 29:10 (Figure 1.1).1-4

Though rare, liver cancer can also occur in childhood with around one child in every million being diagnosed with the condition every year. Liver cancer in children is broadly divided into hepatoblastoma and hepatic carcinomas, which account for around four-fifths (81%) and one-fifth (18%) of cases, respectively.6 Hepatoblastomas are most likely to be diagnosed in children under two years of age.

Read more about liver cancer in children.

Figure 1.1: Liver Cancer (C22), Average Number of New Cases per Year and Age-Specific Incidence Rates, UK, 2007-2009

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Liver cancer incidence rates have overall increased in Great Britain since the mid-1970s (Figure 1.2).1-3 For both men and women, European AS incidence rates increased by around three times between 1975-1977 and 2007-2009.

Much of this increase can probably be attributed to past changes in the prevalence of major risk factors for liver cancer, such as heavy alcohol consumption and infection with the hepatitis B and C viruses.7,8 Alcohol consumption increased in Britain during the 1990s, particularly in women, but the proportion of men and women drinking more than 21 and 14 units/week, respectively, has fallen since 2002.9 A corresponding fall in alcohol-related diseases, including liver cancer, might take a number of years to become apparent, due to the lag between alcohol consumption and related illness. For example, alcoholic liver disease takes approximately ten years to develop.10

Prevalence of infection with hepatitis B and C in the population of the UK over time is unknown, as no true random survey results exist.11 In the US, higher rates of hepatitis infection in the 1960s and 1970s (due to widespread intravenous drug use, sexual practices and unscreened blood transfusions) has been suggested as the main reason for increasing liver cancer rates there.12

Figure 1.2: Liver Cancer (C22), European Age-Standardised Incidence Rates, Great Britain, 1975-2009

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Liver cancer trends for the UK are shown in Figure 1.3.1-4 Over the last decade (between 1998-2000 and 2007-2009), the European AS incidence rates have increased by 40% and 30% in males and females, respectively.

Figure 1.3:  Liver Cancer (C22), European Age-Standardised Incidence Rates, UK, 1993-2009

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Liver cancer incidence rates have overall increased for all of the broad age groups in Great Britain since the mid-1970s (Figure 1.4).1-3 The largest increases have been in people aged 80+, with European AS incidence rates increasing by more than four times between 1975-1977 and 2007-2009.

Figure 1.4: Liver Cancer (C22), European Age-Standardised Incidence Rates, By Age, Great Britain, 1975-2009

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Lifetime risk is an estimation of the risk that a newborn child has of being diagnosed with cancer at some point during their life. It is a summary of risk in the population but genetic and lifestyle factors affect the risk of cancer and so the risk for every individual is different.

In 2010, in the UK, the lifetime risk of developing liver cancer is 1 in 120 for men and 1 in 215 for women.13

The lifetime risk for liver cancer has been calculated by the Statistical Information Team using the ‘Adjusted for Multiple Primaries’ (AMP) method; this accounts for the possibility that someone can have more than one diagnosis of liver cancer over the course of their lifetime.27

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Around half of all cases are liver cell cancers (51% in Great Britain between 2007 and 2009).1-3 These comprise liver cell carcinomas (ICD-10 C22.0), hepatoblastomas (ICD-10 C22.2), angiosarcomas of liver (ICD-10 C22.3), other sarcomas of liver (ICD-10 C22.4) and other specified carcinomas of liver (ICD-10 C22.7).15 Intrahepatic bile duct carcinomas (ICD-10 C22.1) make up a further 40% of the total, and the remaining 9% are of unspecified type.

Liver cell cancers  are more common than intrahepatic bile duct carcinomas in males (62% vs 30%, respectively), while intrahepatic bile duct carcinomas are the most common type in females (57% vs 33%, respectively).1-3

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The majority of liver cell cancers are hepatocellular carcinomas, while the majority of intrahepatic bile duct carcinomas are cholangiocarcinomas.15 There have been dramatic increases in the incidence of cholangiocarcinoma since the early 1970s (increasing 16-fold between 1971-1973 and 1999-2001 in England & Wales). Hepatocellular carcinoma incidence rates have also increased, but not by so much (around three-fold over the same time period). Some of the increase in cholangiocarcinoma incidence may be due to increased detection with new imaging techniques, such as computed tomography which became widely available in the mid-1980s; however this does not explain all of the rise.15 Similar increases in the incidence of intrahepatic cholangiocarcinoma and hepatocellular carcinoma have also been observed in the US between the mid-1970s and 1990s, both of which were thought to be real increases rather than as a result of increased detection.12,16

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Although cancer registration has a long history in many countries of the world, particularly in the more affluent regions such as the UK, nearly 80% of the world’s populations live in regions that are not covered by such systems.17 Nonetheless, with a view to characterising the global burden of the disease, the International Agency for Research on Cancer routinely uses the available data to estimate worldwide cancer incidence.18

Liver cancer is the sixth most common cancer worldwide, with an estimated 750,000 new cases diagnosed in 2008 (6% of the total). Liver cancer incidence rates are highest in Eastern Asia and lowest in South-Central Asia and Northern Europe, with more than ten-fold variation in World AS incidence rates between the regions of the world in males, and around eight-fold variation in females (Figure 1.5).18

Figure 1.5: Liver Cancer (C22), World Age-Standardised Incidence Rates, World Regions, 2008 Estimates 

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Global variation in the prevalence of risk factors for liver cancer explains most of the disparity in incidence between world regions. Worldwide, 77% of liver cancer cases in 2008 were linked to infections, with almost nine out of ten infection-related cases occurring in less developed regions.19 Consumption of foods contaminated with aflatoxin (produced by fungi which can contaminate foodstuffs such as maize and nuts in tropical or sub-tropical countries) is also an important risk factor in some less developed countries.20

Within the 27 countries of the European Union, the highest liver cancer European AS incidence rates for 2008 are estimated to be in Greece for both men and women (around 20 and 7 cases per 100,000, respectively); the lowest rates are estimated to be in The Netherlands for men (around 3 cases per 100,000) and Malta and Cyprus for women (around 1 case per 100,000) (Figure 1.6).21

Figure 1.6: Liver Cancer (C22), European Age-Standardised Incidence Rates, EU-27 Countries, 2008 Estimates 

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UK liver cancer incidence rates are estimated to be the 11th and 14th lowest in males and females, respectively, in Europe (EU-27).21

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Liver cancer incidence is strongly related to deprivation and there is a clear trend of increasing rates with increasing levels of deprivation. The most recent England-wide data for 2000-2004 shows European AS incidence rates are around 83% higher for both men and women living in the most deprived areas compared with the least deprived. It has been estimated that there would have been 430 fewer liver cases each year in England during 2000-2004 if all men and women had experienced the same rates as the most affluent.22 A study in Scotland for 2005-2009 showed that the gap in liver cancer incidence by deprivation is even higher there, with rates for the most deprived men and women being more than twice those for the least deprived.5 Data for liver cancer incidence by socio-economic group are not routinely available for Wales and Northern Ireland.23,24 The higher incidence of liver cancer in more deprived populations can be partly attributed to differences in smoking prevalence, which is much higher in deprived groups compared with affluent in Great Britain.25

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Prevalence refers to the number of people who have previously received a diagnosis of cancer and who are still alive at a given time point. Some patients will have been cured of their disease and others will not. The latest estimates for the UK (Table 1.2) show that around 2,600 men and women were still alive at the end of 2006, up to ten years after being diagnosed with liver cancer.26 Worldwide, it is estimated that there were around 613,000 cancer patients still alive in 2008, up to five years after their diagnosis.18

Table 1.2: Liver Cancer (C22), One, Five and Ten Year Cancer Prevalence, UK, 31st December 2006

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section reviewed 06/09/12
section updated 06/09/12