title: Changing international trends in mortality rates for liver, biliary and pancreatic tumours.
abstract: OBJECTIVE
  The age-standardized mortality rate for hepatocellular carcinoma is increasing in several countries. However, in England and Wales we previously reported an increase in mortality rates from intrahepatic cholangiocarcinoma. Trends in cholangiocarcinoma in most other industrialized countries are unknown. To further study trends in hepatobiliary and pancreatic tumours, we analysed mortality data from the United States, Japan, Australia and Europe.
  
  
  METHODS
  Age-standardized mortality rates for men and women for subcategories of liver tumours, tumours of the gall bladder and extrahepatic biliary tree and pancreas from 1979 to 1998 were obtained from the World Health Organization mortality database.
  
  
  RESULTS
  We confirmed previously reported increases in hepatocellular carcinoma, but also found increases in other countries, particularly Australia (3-year average rise from 1.20 to 2.27, men). Mortality for intrahepatic cholangiocarcinoma increased in men in all countries studied, with the largest increases in Australia (from 0.10 to 0.70) and England and Wales (from 0.20 to 0.83).
  
  
  CONCLUSIONS
  We present a hitherto unreported rise in age-standardized mortality rates from intrahepatic cholangiocarcinoma across four continents. The cause remains uncertain. An impact on the observed trends of improved diagnostic techniques and death certificate misclassification cannot be completely ruled out. Future research should include epidemiological studies to examine possible case-clustering and investigation of potential aetiological and host factors.
authors.affiliation: Liver Unit, Department of Medicine A, Faculty of Medicine, 10th Floor, QEQM Wing, Imperial College School of Medicine, St Mary's Hospital, South Wharf Street, London W2 1PG, UK. shahid.khan@ic.ac.uk
authors.forename: Shahid A
authors.initials: SA
authors.lastname: Khan
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
authors.forename: Mireille B
authors.initials: MB
authors.lastname: Toledano
authors.forename: Angus
authors.initials: A
authors.lastname: Beck
authors.forename: Paul
authors.initials: P
authors.lastname: Elliott
authors.forename: Howard C
authors.initials: HC
authors.lastname: Thomas
mesh_terms: D001315:Australia / Q000453:epidemiology; D001661:Biliary Tract Neoplasms / Q000401:mortality*; D006528:Carcinoma, Hepatocellular / Q000401:mortality; D018281:Cholangiocarcinoma / Q000401:mortality; D005060:Europe / Q000453:epidemiology; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality; D006801:Humans; D038622:Internationality; D007564:Japan / Q000453:epidemiology; D008113:Liver Neoplasms / Q000401:mortality*; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality*; D014481:United States / Q000453:epidemiology