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.
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
Josepa
J
Ribes
Ramon
R
Clèries
Laura
L
Esteban
Víctor
V
Moreno
F Xavier
FX
Bosch
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