title: Alcoholism and liver cirrhosis in the etiology of primary liver cancer.
abstract: 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 diagnosis 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 3,589 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.
authors.affiliation: Cancer Epidemiology Unit, University Hospital, Uppsala, Sweden.
authors.forename: H O
authors.initials: HO
authors.lastname: Adami
authors.forename: A W
authors.initials: AW
authors.lastname: Hsing
authors.forename: J K
authors.initials: JK
authors.lastname: McLaughlin
authors.forename: D
authors.initials: D
authors.lastname: Trichopoulos
authors.forename: D
authors.initials: D
authors.lastname: Hacker
authors.forename: A
authors.initials: A
authors.lastname: Ekbom
authors.forename: I
authors.initials: I
authors.lastname: Persson
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000150:complications* / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000453:epidemiology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000453:epidemiology; D008113:Liver Neoplasms / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012042:Registries; D013548:Sweden / Q000453:epidemiology