By Lisa Rapaport

Liver cancer is the most rapidly rising cause of U.S. cancer deaths, and most of those dying from this disease are people with less education, a new study suggests.

During the study – from 2000 to 2015 – liver cancer death rates nationwide rose from 7.5 to 11.2 fatalities for every 100,000 men ages 25 to 74 and from 2.8 to 3.8 fatalities for every 100,000 women in this age range, researchers note in the journal Cancer.

In men, however, the increases only occurred among those without a college degree. For women, increases occurred with higher education levels but were most pronounced in people without a college degree.

“The rising liver cancer death rates among less educated persons largely reflect their higher rates of liver cancer risk factors, including hepatitis C virus (HCV)-infection, obesity, nonalcoholic fatty liver disease and alcohol use, lower HCV-screening rates, and less access to high-quality care,” said lead study author Jiemin Ma of the American Cancer Society in Atlanta, Georgia.

“We found that the risk of liver cancer death among those with less than a college degree is about twice that of those with a college or advanced degree,” Ma said by email. “This means that about half of the risks of dying from liver cancer among less educated persons would have been mitigated if they had a better job, better insurance, or healthier lifestyle similar to those of people with a college or advanced degree.”

Ma’s team grouped patients into three education levels: up to 12 years (typically a high school education); 13 to 15 years (generally some education beyond high school); and at least 16 years (long enough to earn a college degree).

For every 100,000 men with less than a high school education, liver cancer death rates rose during the study period from 10.23 to 17.84 fatalities. Over that same period, liver cancer death rates declined 3 percent for men with a college education.

Among women, liver cancer death rates rose across all education levels, with the smallest increase for college-educated women. Death rates climbed from 3.62 to 5.29 fatalities for every 100,000 women with less than a high school education; and they rose from 1.83 to 3.08 fatalities for every 100,000 without a college degree.

Although death rates increased faster for liver cancers related to HCV, the overall liver cancer mortality trends were largely driven by HCV-unrelated liver cancers, the study also found.

The study wasn’t a controlled experiment designed to prove whether or how education levels might directly impact cancer fatalities, and it also didn’t assess other aspects of socioeconomic status like household income and occupation.

“It’s long been said that poverty is a cause of cancer, and education is often a stand-in for socioeconomic status,” said Dr. Graham Colditz, a researcher at Washington University School of Medicine in Saint Louis, Missouri, who wasn’t involved in the study.

“People with lower incomes, lower education, fewer personal and community resources are more likely to have higher rates of risk factors for liver cancer (HCV infection, obesity, diabetes, alcohol use, tobacco use),” Colditz said by email. “They are also less likely to be hooked into medical care, where they can be diagnosed and treated in a timely manner. Access to health information and prevention may also be limited.”

SOURCE: Cancer, online April 8, 2019.