Diabetes: A risk factor for liver cancer across ethnic groups

Diabetes was associated with an increased risk for developing hepatocellular carcinoma, a type of liver cancer, and this association was highest for Latinos, followed by Hawaiians, African-Americans, and Japanese-Americans, according to results presented  at the Sixth American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held Dec. 6-9, in Atlanta.

V. Wendy Setiawan, PhD, assistant professor, department of preventive medicine at Keck School of Medicine of the University of Southern California, and colleagues examined if the association between diabetes and hepatocellular carcinoma differed by race/ethnic group. They analyzed data from more than 150,000 people enrolled in the Multiethnic Cohort Study between 1993 and 1996. During the follow-up period of about 15 years, 506 cases of hepatocellular carcinoma were reported: 59 cases in non-Hispanic whites, 81 in African-Americans, 33 in Hawaiians, 158 in Japanese-Americans, and 175 in Latinos. 

Compared with non-Hispanic whites, Latinos had 2.77 times the risk for being diagnosed with hepatocellular carcinoma, the highest risk identified. Native Hawaiians had 2.48 times the risk; African-Americans, 2.16; and Japanese-Americans, 2.07. 

The prevalence of diabetes was consistent with that of hepatocellular carcinoma. Sixteen percent of Hawaiians, 15% of Latinos and African-Americans, 10% of Japanese-Americans, and 6% of non-Hispanic whites had diabetes. Compared with those without diabetes, Latinos with diabetes had 3.3-fold higher risk for hepatocellular carcinoma; Hawaiians, 2.33-fold higher risk; Japanese-Americans, 2.02-fold higher risk; African-Americans, 2.02-fold higher risk; and non-Hispanic whites had 2.17-fold higher risk. 

Hepatocellular carcinoma was attributed to diabetes in 26% of cases in Latinos, 20% of Hawaiians, 13% of African-Americans, 12% of Japanese-Americans, and 6% of non-Hispanic whites, the researchers estimated. According to Setiawan, eliminating diabetes could potentially reduce hepatocellular carcinoma incidence in all racial/ethnic groups, with the largest potential reduction possible in Latinos. 

“People with diabetes have a 2- to 3-fold higher risk for hepatocellular carcinoma compared with those without diabetes,” Setiawan said in a press release. “We also found that the interethnic differences in the prevalence of diabetes were consistent with the pattern of hepatocellular carcinoma incidence observed across ethnicities: Ethnic groups with a high prevalence of diabetes also have high hepatocellular carcinoma rates, and those with a lower prevalence of diabetes have lower hepatocellular carcinoma rates.” 

New cases of hepatocellular carcinoma in the United States tripled in the past 3 decades, with Latinos and African-Americans experiencing the largest increase in incidence. According to prior research, diabetes may be a risk factor for hepatocellular carcinoma, and its increasing incidence may be contributing to the rising rate of hepatocellular carcinoma. 

“People with diabetes should be aware that their condition is associated with a higher risk of developing hepatocellular carcinoma,” Setiawan said. “Maintaining a healthy weight, managing their diabetes, preventing and treating hepatitis infection, and limiting alcohol and tobacco use should be in their priority to-do list.”

Public health efforts encouraging obesity/diabetes prevention and effective diabetes management should be directed at high-risk populations, Setiawan added.

This study was funded by the National Cancer Institute. Setiawan has declared no conflicts of interest.