The influence of alcohol consumption and hepatitis B and C infections on the risk of liver cancer in Europe.
OBJECTIVE
To assess the variability of liver cancer (LC) risk associated with hepatitis B (HBV) and hepatitis C (HCV) viruses and alcohol intake in 2002 throughout Europe.


METHODS
Incidence data were obtained from population-based cancer registries whereas mortality, HBV, HCV and alcohol exposures were obtained from the WHO databases. Relative risk of LC and their posterior probabilities to be >1 were obtained and plotted in maps through a Bayesian random effects model.


RESULTS
HBV prevalence >2% increased the risk of developing LC a 15% in men and 21% in women; HCV prevalence >2%, 54% in men and 33% in women and, pure alcohol intake >11l, 26% and 14%, respectively (all of them statistically significant). These risk factors played a similar role in the risk of dying from LC among men, whereas HBV and alcohol were not statistically significant among women. Significant high LC risk, after HBV/HCV and alcohol adjustment were observed for both sexes in: Hungary, Moldova, Romania, Croatia, Greece, Italy, Spain, France and Austria.


CONCLUSIONS
South-North and East-West decreasing gradients for LC risk were observed in Europe. HBV, alcohol and, mainly, HCV are independent risk factors that could explain this geographical pattern.
Ribes
Josepa
J
Catalan Cancer Plan, IDIBELL, Catalan Institute of Oncology, Avda. Gran Via s/n, Km. 2,7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. j.ribes@iconcologia.net
Clèries
Ramon
R
Esteban
Laura
L
Moreno
Víctor
V
Bosch
F Xavier
FX
D000428:Alcohol Drinking / Q000401:mortality*; D001499:Bayes Theorem; D005060:Europe / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000401:mortality*; D006526:Hepatitis C / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000401:mortality*; D008297:Male; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014944:World Health Organization