Increase in mortality rates from intrahepatic cholangiocarcinoma in England and Wales 1968-1998

Background-The age standardised mortality rate per 100 000 population for a ll 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 anatomica l subcategories were involved. Methods-Mortality statistics for liver tumours of ICD-9 155, 156, and subca tegories, and for tumours of the pancreas (ICD-9 157), in England and Wales were investigated from the Office for National Statistics, London, from 19 68 to 1996 inclusive. Data for 1997 and 1998 were also available on intrahe patic cholangiocarcinomas. Results-There has been a marked rise in age standardised mortality rates fo r 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 fr om other primary liver tumours, including hepatocellular carcinoma, were un remarkable. Conclusions-The observed increase in mortality from intrahepatic cholangioc arcinoma may represent better case ascertainment and diagnosis due to impro ved diagnostic imaging, use of image guided biopsies, or increased use of E RCP. However, the trend started before ERCP was introduced nationally, mort ality rates have continued to increase steadily thereafter, and there is no clear evidence that diagnostic transfers easily explains the findings. Alt ernatively, these observations may represent a true increase in intrahepati c bile duct tumours. Epidemiological studies are required to determine whet her there is any geographical clustering of cases around the UK.