Diabetes & hepatocellular carcinoma (HCC)

Hepatocellular carcinoma is a common cancer worldwide. The incidence in the East is very much higher due to endemic chronic hepatitis B virus (HBV) infection in the population. The incidence of HCC has been increasing steadily in USA and the major risk factor for HCC in US is chronic hepatitis C virus (HCV) infection. In 1975, the total incidence of HCC was approximately 1.59 per 100,000 person-years. By 2006, this had reached 4.82 per 100,000 person-years and this increase has been attributed to the increasing numbers of Asian immigrants in the United States. However, a presentation at the recent 101^st Annual Meeting of the American Association for Cancer Research (AACR) has come up with a surprising culprit (Abstract 1816, presented Arpil 19, 2010).

Researchers from the National Cancer Institute (NCI) reviewed data from the NCI SEER database. The case population studied consisted of 5607 people diagnosed with HCC. They examined the odds ratio of an individual developing HCC with the risk factors of HCV infection, HBV infection, alcohol-related disease, rare metabolic disease, diabetes and obesity. (Odds ratio tells you how much more likely it is that you are going to develop the condition compared with someone without the risk factor.) HCV infection has the highest odds ratio of 44.26 (ie 44 x more likely than a non HCV infected person). The odds ratios for HBV infection, alcohol-related disease, rare metabolic disorder, diabetes and obesity were 13.37, 4.43, 3.51, 2.37 and 1.53, respectively. However, the researchers found that diabetes was associated with the greatest percentage of cases (33.5%). The other associations were alcohol-related disorders (23.9%), HCV infection (20.7%), HBV infection (5.7%), rare metabolic disorders (3.1%) and obesity (2.7%).

The incidence of obesity and diabetes mellitus is increasing worldwide and the Asian population has not been spared. While chronic HBV infection is the most important risk factor for HCC in Asia, the general population and clinicians need to be aware that diabetes and obesity are also associated with HCC. The above study found that 67.9% of Asians with HCC had one or more of the identified risk factors. Both obesity and diabetes can be helped by adopting a prudent life style - maintaining a healthy body starts with you!