Liver Cancer Prevalence Linked to Diabetes

Investigators have identified an association between diabetes and the risk of developing hepatocellular carcinoma (HCC)—a form of liver cancer that has been increasing in incidence in the United States. New cases have tripled over the past three decades.

The findings were presented December 8 at the AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities in Atlanta.

“There is no way we can tell which diabetic patients will and will not develop HCC,” said presenter V. Wendy Setiawan, PhD, assistant professor in the Department of Preventive Medicine at University of Southern California’s Keck School of Medicine. “All we can say is that persons with diabetes are at increased risk of developing HCC compared to those without diabetes.” Specifically, the research showed that risk is 2- to 3-fold higher in diabetic patients.

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Setiawan and colleagues analyzed data from nearly 170,000 people enrolled in the Multiethnic Cohort Study between 1993 and 1996. During the follow-up period of about 15 years, 506 cases of HCC were reported. They found the association between diabetes and HCC disproportionately affects certain ethnic groups in the same way that diabetes does—those with a higher incidence of diabetes also showed higher rates of HCC.

Compared to those without diabetes, the risk for HCC was:

• 3.3-fold higher in Latinos with diabetes.
• 2.33-fold higher risk in Hawaiians with diabetes.
• 2.17-fold higher in non-Hispanic whites with diabetes.
• 2.02-fold higher in Japanese-Americans and African-Americans with diabetes.

“Certain ethnicities are at greater risk of developing HCC than others, possibly due to differences in the prevalence of HCC risk factors (they have higher prevalence of hepatitis B or C infection, they drink and smoke more, they are heavier, etc.) and their genetic makeup might make them more susceptible to HCC,” Setiawan said.

The research suggests that eliminating diabetes could potentially reduce rates of HCC in all racial/ethnic groups, with the largest potential reduction in the incidence among Latinos.

Setiawan recommends talking with diabetic patients about the higher risk of developing HCC (among other complications) associated with their condition. Stress that they manage their diabetes properly, maintain a healthy weight, limit alcohol consumption and tobacco use, and prevent or treat hepatitis infection.

“Diabetic patients who also have nonalcoholic fatty liver disease should probably receive similar screening guidelines as those considered at-risk patients for HCC (i.e., those with cirrhosis, chronic hepatitis B or C, or other liver injury): α-fetoprotein tests and ultrasound to detect HCC in its early stages,” Setiwan added.

She would like to do additional studies to determine whether HCC risk among diabetics is affected by diabetes medication, duration, and other factors. In addition, she’s interested in investigating whether diabetes is associated with a higher risk of having advanced cancer at the time of diagnosis and with worse prognosis.

—Colleen Mullarkey

Reference

Setiawan VW, Hernandez B, Stram D, Wilkens L, Le Marchand L, Henderson BE. Diabetes and racial/ethnic differences in hepatocellular carcinoma risk: the Multiethnic Cohort. AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities 2013; PR09.