Liver :: Racial and geographic disparities in the utilization of surgical therapy for hepatocellular carcinoma

Hepatocellular carcinoma (HCC), a cancer of cells in the liver, is on the rise in part due to the high prevalence of chronic hepatitis C infection, which increases the risk for the disease.

Surgery is the only potential curative treatment for HCC and this study sought to determine the patterns of use for this treatment.

Researchers from the University of Michigan Health System in Ann Arbor, Mich., and the Johns Hopkins University School of Medicine in Baltimore, Md., reviewed data of all HCC patients submitted to the Surveillance, Epidemiology and End Results (SEER) National Cancer Institute registry between 1998 and 2003. A total of 14,902 patients with HCC were included in the analysis, 20 percent of whom underwent surgical therapy (8.5% resection, 6.1% ablation and 4.9% transplant). The use of surgery to treat HCC increased five percent per year during that timeframe.

After reviewing the data, investigators found that racial and regional disparities can affect whether or not liver cancer patients receive important, life-saving surgical treatment. There were geographic differences in the use of surgery for HCC, ranging from eight percent in Georgia to 31 percent in Alaska and Hawaii. Younger women with a single, small tumor were most likely to undergo surgery. African Americans were 25 percent less likely to receive surgical therapy than white patients, while Asian patients were 27 percent more likely to receive it. Interestingly, people who lived in densely populated counties with higher rates of unemployment were not as likely to be offered surgery to treat HCC.

“Significant racial and regional differences exist in the utilization of surgical therapy for hepatocellular carcinoma,” said Christopher J. Sonnenday, M.D., of the University of Michigan Health System in Ann Arbor and lead author of the study. “Possible explanations for this could be that patients are refusing treatment, that they are unable or unwilling to seek therapy outside of their immediate community, or perhaps they are not being offered therapy at all by their physicians. Further investigation is needed to understand the reason for these differences to ensure that surgery is available to those who need it, as it is really the only potential cure for HCC.”