title: Incidence and survival for hepatic, pancreatic and biliary cancers in England between 1998 and 2007.
abstract: BACKGROUND
  Hepatic, pancreatic and biliary (HPB) cancers are a group of diverse malignancies managed ideally in specialist centres. This study describes recent patterns in the incidence and survival of HPB cancers in England over a ten year period (1998-2007).
  
  
  METHODS
  Data on 99,379 English patients (50,656 males; 48,723 females) diagnosed with HPB cancers between 1998 and 2007 were extracted from the National Cancer Data Repository. Data were divided into six site-specific cancer groups; pancreas, ampulla of Vater, biliary tract, primary liver, gallbladder and duodenum. Age-standardised incidence rates (per 100,000 European standard population, (ASR(E))) were calculated for each of the six groups by year of diagnosis and by socioeconomic deprivation. Survival was estimated using the Kaplan-Meier method.
  
  
  RESULTS
  The largest group was pancreatic cancers (63%), followed by primary liver (14%) and biliary cancers (13%). ASR(E) were highest for pancreatic and primary liver cancers whereas cancers of the gallbladder, duodenum and ampulla of Vater had a very low incidence. Over time the incidence of all six groups remained relatively stable, although primary liver cancer increased slightly in males. Incidence rates were higher in males than in females in all groups except gallbladder cancer, and all six groups had a higher incidence in the more deprived quintiles. Overall survival was poor in each of the HPB cancer groups.
  
  
  CONCLUSIONS
  HPB tumours are uncommon and are associated with poor long term survival reflecting the late stage at presentation. Incidence patterns suggest variable rates linked to socioeconomic deprivation and highlight a male predominance in all sites except the gallbladder. Identification of high risk populations should be emphasised in initiatives to raise awareness and facilitate earlier diagnosis.
authors.affiliation: King's College London, Thames Cancer Registry, 1st Floor Capital House, 42, Weston Street, London SE1 3QD, UK. victoria.coupland@kcl.ac.uk
authors.forename: Victoria H
authors.initials: VH
authors.lastname: Coupland
authors.forename: Hemant M
authors.initials: HM
authors.lastname: Kocher
authors.forename: David P
authors.initials: DP
authors.lastname: Berry
authors.forename: William
authors.initials: W
authors.lastname: Allum
authors.forename: Karen M
authors.initials: KM
authors.lastname: Linklater
authors.forename: Julie
authors.initials: J
authors.lastname: Konfortion
authors.forename: Henrik
authors.initials: H
authors.lastname: Møller
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Davies
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001661:Biliary Tract Neoplasms / Q000453:epidemiology* / Q000401:mortality; D004739:England / Q000453:epidemiology; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology* / Q000401:mortality; D015996:Survival Rate