title: Increase in mortality rates from intrahepatic cholangiocarcinoma in England and Wales 1968-1998.
abstract: BACKGROUND
  The age standardised mortality rate per 100 000 population for all causes of liver tumours (International Classification of Disease 9 (ICD-9) 155) has almost doubled in England and Wales during the period 1979-1996. We further analysed the mortality statistics to determine which anatomical subcategories were involved.
  
  
  METHODS
  Mortality statistics for liver tumours of ICD-9 155, 156, and subcategories, and for tumours of the pancreas (ICD-9 157), in England and Wales were investigated from the Office for National Statistics, London, from 1968 to 1996 inclusive. Data for 1997 and 1998 were also available on intrahepatic cholangiocarcinomas.
  
  
  RESULTS
  There has been a marked rise in age standardised mortality rates for intrahepatic cholangiocarcinoma. Since 1993, it represents the commonest recorded cause of liver tumour related death in England and Wales. This is evident in age groups older than 45 years. In contrast, mortality trends from other primary liver tumours, including hepatocellular carcinoma, were unremarkable.
  
  
  CONCLUSIONS
  The observed increase in mortality from intrahepatic cholangiocarcinoma may represent better case ascertainment and diagnosis due to improved diagnostic imaging, use of image guided biopsies, or increased use of ERCP. However, the trend started before ERCP was introduced nationally, mortality rates have continued to increase steadily thereafter, and there is no clear evidence that diagnostic transfers easily explains the findings. Alternatively, these observations may represent a true increase in intrahepatic bile duct tumours. Epidemiological studies are required to determine whether there is any geographical clustering of cases around the UK.
authors.affiliation: Liver Unit, Department of Medicine A, Imperial College School of Medicine, St Mary's Campus, South Wharf Street, London W2 1PG, UK. s.taylor-robinson@ic.ac.uk
authors.forename: S D
authors.initials: SD
authors.lastname: Taylor-Robinson
authors.forename: M B
authors.initials: MB
authors.lastname: Toledano
authors.forename: S
authors.initials: S
authors.lastname: Arora
authors.forename: T J
authors.initials: TJ
authors.lastname: Keegan
authors.forename: S
authors.initials: S
authors.lastname: Hargreaves
authors.forename: A
authors.initials: A
authors.lastname: Beck
authors.forename: S A
authors.initials: SA
authors.lastname: Khan
authors.forename: P
authors.initials: P
authors.lastname: Elliott
authors.forename: H C
authors.initials: HC
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis / Q000401:mortality*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000175:diagnosis / Q000401:mortality*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014852:Wales / Q000453:epidemiology