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Alcoholism and liver cirrhosis in the etiology of primary liver cancer
Author(s) -
Adami HansOiov,
Hsing Ann W.,
McLaughlin Joseph K.,
Trichopoulos Dimitrios,
Hacker David,
Ekbom Anders,
Persson Ingemar
Publication year - 1992
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.2910510611
Subject(s) - cirrhosis , medicine , liver cancer , gastroenterology , population , etiology , relative risk , cancer , incidence (geometry) , hepatitis , alcoholic liver disease , hepatitis b , confidence interval , physics , environmental health , optics
The aim of this study was to determine the risk of developing primary liver cancer in patients with a diagnosis of alcoholism, liver cirrhosis, or both. Three population‐based, mutually exclusive cohorts were defined on the basis of hospital discharge diagnoses between 1965 and 1983. Complete follow‐up through 1984—excluding the first year of follow‐up—showed that among 8,517 patients with a diagnosis of alcoholism, 13 cancers occurred, vs. 4.2 expected (standardized incidence ratio (SIR) = 3.1; 95% confidence interval (CI) = 1.6 to 5.3); among 3389 patients with liver cirrhosis, 59 cancers occurred, vs. 1.7 expected (SIR = 35.1; 95% CI = 26.7 to 45.3), and among 836 patients with both diagnoses, 11 cancers occurred, vs. 0.3 expected (SIR = 34.3; 95% CI = 17.1 to 61.3). Thus, alcoholism alone entailed a moderately increased risk and alcoholism with liver cirrhosis did not increase the high relative risk for liver cancer more than cirrhosis alone. We conclude that alcohol intake may be a liver carcinogen only by being causally involved in the development of cirrhosis; and further, that the risk of developing liver cancer following cirrhosis in this population is similar to or higher than that after chronic hepatitis‐B‐virus infection in other Western countries.