Incidence of Liver Cancer Expected to Climb as Hepatitis C Progresses

Death, according to the experts, will come from the progression of the disease, first to cirrhosis, a severe disease of the liver that prevents normal functioning and body metabolism, and then to liver cancer, known in the medical world as hepatocellular carcinoma (HCC). Either one of these progressive patterns may result in bodily dysfunction and death.

Once considered a rare disease in the U.S., the CDC now predicts hepatitis C-associated mortality will increase two- to threefold.

John B. Wong, MD, chief of the division of clinical decision making at the New England Medical Center at Tufts University School of Medicine in Boston, tells WebMD that he used a computer model to check predictions issued last year by the CDC. "Our model confirmed the CDC estimate. We predict that 208,000 Americans will die as a result of HCV in the years 2010-2019," he says.

The price tag for hepatitis C during the decade 2010-2019 will be about $82 billion, says Wong. That prediction is based on estimates of approximately $10 billion in treatment costs and $71 billion in lost productivity.

Wong points out that hepatitis C is a "viral infection with a very long lag time from exposure to progression." The natural history of the disease takes it from fibrosis to cirrhosis to -- for those who don't die from cirrhosis -- to HCC, he says. "Our study predicts that 181,300 deaths will occur from HCV-related cirrhosis and 27,200 from HCV-related HCC."

That prediction is echoed by Masashi Mizokami, MD, who is a professor of medicine at the Nagoya City University Medical School in Japan. Mizokami tells WebMD that hepatitis C infection began to diverge in Japan around 1945. The virus is most efficiently transmitted by intravenous drug use, says Mizokami.

During World War II, the military government of Japan introduced methamphetamine to the soldiers to increase the 'fighting spirit.' As a result, intravenous use of methamphetamine grew steadily from the mid-1940s to the 1950s, he says. In the U.S., use of intravenous drug use became prevalent in the 1960s, so Mizokami refers to the year 1965 as the date for initial divergence of hepatitis C in the U.S. and 1945 for divergence in Japan.

Hepatitis C progresses for about 30 years, according to Mizokami, "and I think this explains the difference in prevalence of HCC between Japan and the U.S.," he says. Although the incidence of hepatitis C is virtually the same in the U.S. and Japan, the incidence of HCC is eight times greater in Japan, he says.

In Japan, the incidence of "HCC began to climb in 1975," Mizokami says. He notes that "in 1995, the incidence of cirrhosis in the U.S. began to climb, and it appears that this will signal the beginning of the same pattern seen in Japan," he says.

Since combination therapy with the drugs interferon and ribavirin can achieve a response in 40-50% of patients with hepatitis C, WebMD asked Mizokami if treatment would alter the future path of the disease in the U.S. "We don't know," he says. "We have only had the combination available since 1997, so it is too early to predict."