Why Are Deaths From Liver Cancer So High Among Hispanic And Latino Communities?

Not everyone is affected by liver cancer equally.

Read on to learn about the racial and ethnic disparities in liver cancer prevalence, diagnosis, treatment, and prognosis, and understand why death rates are so high in Hispanic and Latino communities.

Understanding liver cancer

Cancer is an uncontrollable growth of tissue cells, causing tumors that can spread to other body parts. This happens as a result of mutations in the genes that control cell division and growth, causing the cells to change from normal to malignant.

Malignant tumors are cancerous. They are growths that, if left unchecked, will spread through the body and cause widespread disease. Some cancers are very slow growing, while others can grow very rapidly.

Some tumors are benign. This means that although there may be a lump or mass, there’s no risk of the tumor spreading. A benign tumor causes very little to no damage.

The genetic mutation that causes cancer could be inherited or acquired due to many potential environmental and lifestyle factors. These might include smoking, alcohol, exposure to chemicals, or UV damage.

The most common type of liver cancer (90%) is hepatocellular carcinoma (HCC).¹

Globally, HCC is one of the most common types of cancer. It has the second highest mortality rate of all cancers found in men after lung cancer.²

Rarer forms of liver cancer include fibrolamellar hepatocellular carcinoma (FHCC), cancer of the bile ducts (cholangiocarcinoma), cancer of the liver blood vessels (angiosarcoma), and liver cancers in children (hepatoblastoma).³ ⁴ ⁵

Liver cancers are quite rare in the US. They made up only 2.1% of all new cancer cases in 2023. Despite this, they have a much higher impact per case than other cancers due to their high mortality rates. At just 21.6%, liver cancers have one of the worst five-year relative survival rates.⁶ ⁷

Hispanic and Latino people have a much higher incidence of liver cancer than other ethnic groups.

For instance, in 2020, the total incidence rate per 100,000 males from all racial and ethnic backgrounds was 14.1. However, Hispanic and Latino men have a much higher incidence rate of 21.7. Women have significantly lower incidence rates: 5.2 overall per 100,000 women and 9.0 for Hispanic and Latino women.⁸ ⁹ ¹⁰

The only race with an incidence rate of liver cancer higher than Hispanic people is non-Hispanic Native American/Alaska Natives (AI/AN). In 2020, AI/AN people had an incidence rate per 100,000 of 26.8 for men and 11.5 for women.¹¹

This trend also extends to mortality rates. Hispanic and Latino people currently have the second highest death rate from liver cancer after AI/AN people. Hispanic and Latino people are 1.7 times more likely to die from liver cancer than White people.¹²

Terminology

Throughout this article, we will use terms like Hispanic and Latino interchangeably. It’s important to remember that these terms denote different groups, but they are often linked in scientific articles.¹³

We have chosen to continue using the terms in this way throughout this article, following the method seen in the cited census data and research studies. 

The term Hispanic refers to people who have ancestry from a country where Spanish is the primary language. The term Latino refers to people who have ancestry from a country in Latin America.¹⁴

Risk factors for hepatocellular carcinoma

Below are some possible risk factors for developing HCC:

Sex

HCC is more common in men than women, although FHCC is more common in women.¹⁵

Race

The group most at risk of HCC in the US is non-Hispanic AI/AN people. This is followed by Hispanic and Latino people.¹⁶

In the past few decades, non-Hispanic Asian/Pacific Islanders had the highest incidence rate per 100,000 people. The incidence in this group has been declining significantly, and it is now the third most affected group. Meanwhile, rates in non-Hispanic AI/AN people and Hispanic people have been increasing.

When race is a risk factor for a disease, it often points to a potential genetic predisposition to the disease or its risk factors.

The PNPLA3 gene polymorphism is a genetic predisposition commonly found in the Hispanic population. This polymorphism has been linked to an increase in the liver’s fat composition, as well as a higher inflammatory state. Both these factors may cause elevated levels of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) — conditions that can significantly increase your risk of HCC.¹⁷

Chronic viral hepatitis

Chronic viral hepatitis in the forms of hepatitis B and hepatitis C can lead to cirrhosis, which can increase your risk of developing liver cancer.¹⁸

NAFLD

NAFLD is a liver disease caused by an accumulation of fat cells in the liver. NAFLD occurs despite low levels of alcohol use, and can have some detrimental effects on liver function.¹⁹

NASH

NASH is an advanced stage of NAFLD. Some people with NAFLD will progress to NASH, although it’s unclear why this occurs more in some people than others.²⁰

NASH is caused by chronic inflammation due to the accumulation of fatty cells in the liver. This inflammation can cause scarring and, eventually, loss of liver function.

Cirrhosis

Cirrhosis is characterized by scar tissue in the liver. This occurs when liver cells become damaged. As they heal, they turn into scar tissue. These scars impair the liver’s ability to regenerate new tissue, leading to a lack of liver function.²¹

Cirrhosis increases the risk of liver cancer and is often found when liver cancer is diagnosed.

The disease is commonly caused by excessive drinking, chronic infection, progression from NAFLD/NASH, or, less commonly, an autoimmune disease known as primary biliary cirrhosis.

Smoking

Smoking tobacco products can harm the liver by increasing the progression and severity of liver diseases like fibrosis (scarring that inhibits liver function) and liver cancer.²²

Excessive alcohol consumption

Excessive drinking can increase your risk of liver disease.

The liver is extremely important for metabolizing alcohol when you drink, and excessive drinking can cause a buildup of fats in the liver.²³

Hepatitis

Hepatitis simply means inflammation of the liver. Other than hepatitis caused by viruses, this condition could result from using certain medications, exposure to toxins, alcohol consumption, or autoimmune disease.²⁴

Type 1 or 2 diabetes

Diabetes can also increase your risk of liver cancer. However, this usually only affects people who already have another risk factor.

Having a high BMI is common in people with type 2 diabetes. This can also increase your risk of liver cancer.²⁵

Obesity

Being heavily overweight or having obesity is often associated with an increased risk profile for some cancers, including liver cancer. This is likely due to the increased risk of NAFLD or NASH.²⁶

Diet

Diet can play a role in the development of various diseases, including liver cancer.

Consuming lots of trans fats often leads to an accumulation of cholesterol and hyperlipidemia — precursors to diabetes. It can also increase your risk of NAFLD or NASH — risk factors for liver cancer.²⁷

Exposure to toxins

Aflatoxins

Aflatoxins are carcinogens (cancer-causers). A natural fungal contaminant of high-quantity crops like wheat and soybeans creates these toxins. When these crops are stored improperly in a warm or moist environment, growth of this dangerous fungus significantly increases.

Long-term exposure to aflatoxins raises your risk for liver cancer, particularly if you have other risk factors.²⁸

Vinyl chloride

Vinyl chloride — a carcinogen — is used to produce some plastics. It increases the risk of angiosarcoma.²⁹

Thorium dioxide

Thorium dioxide was used for X-rays as a contrast liquid to make the X-ray easier to read. However, it was found to be a carcinogen and is no longer used.³⁰

Rare diseases

Having some diseases can increase your risk of liver cancer, including the following:

• Wilson disease

• Issues with storing glycogen

• Tyrosinemia

• Porphyria cutanea tarda

• A1-antitrypsin deficiency

Factors causing higher HCC mortality rates in Hispanic and Latino communities

The incidence and mortality rates of liver cancer are much higher (by around 50%) in Hispanic and Latino people compared to their non-Hispanic White counterparts.³¹

The reasons for this are multifactorial and include biological, socioeconomic, environmental, and healthcare differences.

Biological

Comorbidities

HCC has several risk factors that can be mediated through lifestyle behaviors (such as your smoking status and diet) or controlled through medication (like diabetes and kidney disease).

Research revealed that Hispanic and Latino people with HCC are more likely to have comorbid conditions. These include diabetes, hyperlipidemia, NASH, and kidney disease. Notably, Hispanic participants in the study were less likely to have hepatitis C or a history of smoking than people from some other races.³²

Metabolic conditions

Metabolic conditions like obesity and type 2 diabetes are risk factors for liver cancer. These conditions are more common in Hispanic populations. The only other racial group in the US with a higher incidence of these two conditions is non-Hispanic Black.³³

HCV-positive

Hepatitis C (HCV) is associated with a higher incidence of liver cancer.

A study noted that HCV-positive Hispanic people have a higher risk of developing cirrhosis (a risk factor for HCC). Even after adjusting for comorbid conditions, such as human immunodeficiency virus (HIV) co-infection, obesity, and diabetes, Hispanic people still had a higher risk of developing cirrhosis and HCC compared to non-Hispanic White people.³⁴

Genetics

Genetics could potentially explain some of the disparity in HCC rates between different races.

Some genes that are associated with a much higher fat content in the liver and inflammatory state are more common among Hispanic and Latino people. Some of these genes also contribute to a more aggressive disease course.³⁵

Socioeconomic factors

Socioeconomic status

Socioeconomic status (SES) is often overlooked when thinking about health. It can strongly impact the basic determinants of health, like the food you eat, the quality of air you breathe, and the environment you spend most of your time in.

HCC has a strong disparity between high and low SES. Its prevalence is higher for all races in the lowest socioeconomic group, except AI/AN people.³⁶

SES also affects the stage of cancer diagnosed. You are more likely to be diagnosed with a serious stage of HCC if you are in a lower socioeconomic group. This may partly explain the higher incidence of mortality in people with low SES.³⁷

Furthermore, unmeasured statistics like SES, financial stability, and even cultural identities and perceived stigmas may prevent some populations from receiving equitable care. Understanding and accounting for these differences is an essential step toward providing equitable care for everyone, no matter their racial or ethnic background.³⁸

Education

Even something as simple as attending regular health checkups and screenings can be disparate among socioeconomic groups.

More educated socioeconomic groups are more likely to receive cancer screening than those who have not been afforded the same opportunities. Having a higher level of education often improves your health literacy, which can significantly affect your likelihood of adopting unhealthy habits or lifestyle behaviors that influence your risk of developing liver cancer.³⁹

Environment

Where you live can seriously impact your health. People who live in rural or suburban areas are much more likely to present with later stages of HCC than their urban counterparts. They are also more likely to die from the disease.⁴⁰

The country you live in can also affect your care. A study found that Hispanic people born outside of the US are more likely to have a higher risk and incidence of liver cancers. They are also more likely to develop them at a younger age.⁴¹

Environmental stressors may also be strongly related to HCC risk. For example, cadmium is a chemical toxin that has been linked to cancer and increasing HCC stressors such as cirrhosis, fatty liver, and NASH.⁴²

Cadmium is found in much higher concentrations among some populations, including Black, Hispanic, and Latino. This is because many industrial areas are located near disadvantaged minority groups. The racial distribution of the geographic cluster with the highest cadmium exposure is estimated to be 2% White, 78% Black, and 14% Hispanic.⁴³

Healthcare

Poor access to healthcare is a well-established issue that affects people differently depending on their race and ethnicity. This may explain disparities in HCC incidence and mortality rates.⁴⁴

Screening

Although early screening is a best practice for improving HCC outcomes, screening services are less accessible to Hispanic and Latino populations compared to White populations. This often leads to the disease not being discovered until it has progressed, worsening outcomes.

Access to immunotherapy

Compared to White patients, Hispanic patients are less likely to receive immunotherapy for advanced-stage HCC. Immunotherapy is associated with better overall survival compared to chemotherapy in cases of advanced HCC.⁴⁵

Insurance status

Hispanic and Latino people are more likely to be uninsured or insured by the state compared to their White counterparts. This is despite regulations like the Affordable Care Act.

Low insurance rates result from the leading workplaces in these communities offering less insurance. In 2019, 20% of Latino people were uninsured, while this figure was only 8% for White people.⁴⁶ ⁴⁷

A study found that HCC mortality was not associated with race and ethnicity among White, Black, and Hispanic patients after adjusting for insurance coverage and the health system.⁴⁸

Therapeutic treatment

Research shows that Hispanic people are less likely to receive curative treatment than White people, even after adjusting for insurance status and tumor stage at diagnosis.⁴⁹

Even when presenting with early-stage HCC, Black and Hispanic people are the least likely of all racial minority groups to receive HCC treatment. They are also less likely to receive curative therapies (such as hepatic resection and ablation).

Accessibility of transplantation and surgical procedures

Significant racial and ethnic disparities may exist between Hispanic and White people in access to liver transplantation for HCC.⁵⁰

Preventing hepatocellular carcinoma

Preventing HCC is not always possible, but you can lower your chances of developing it with these tips:

• Exercise and eat well for good metabolic health and type 2 diabetes prevention

• Maintain a healthy weight

• Avoid trans fats and high levels of saturated fats and sugar

• Lower blood pressure

• Quit smoking

• Reduce or quit drinking

• Vaccinate against hepatitis

• Practice safe sex

• Reduce your exposure to toxins and chemicals

Reduction measures in practice

Several measures are in place to reduce the incidence and mortality of HCC. 

Vaccination

Vaccination against hepatitis B is one of the most effective and easy ways to reduce your risk of HCC.

Improving health literacy and screening for early detection

Other measures include improving health literacy about HCC, its risk factors, and the importance of screening and early detection. This will help improve access to care and awareness of the importance of avoiding certain risk factors. It can also give people the knowledge they need to identify symptoms and seek timely medical advice. ⁵¹

Health insurance

Increasing access to health insurance should also be a priority, as a lack of access to healthcare is known to be associated with high HCC mortality rates. Steps should be taken to improve affordable, high-quality healthcare through federal and government programs.

Culturally tailored programs

A culturally-tailored program, like an educational program, should aim to help Hispanic people learn about HCC and how to prevent it. They should also seek to remove potential barriers to access, like language.

Some culturally tailored programs like this already exist, like the pilot Healthy Liver/Hígado Sano study. However, more are needed to reduce the health disparity evident among different populations with HCC.⁵²

The lowdown

Liver cancer is a serious condition that’s more common in Hispanic and Latino populations. This is due to a combination of factors, including biological, cultural, and socioeconomic differences.

Some of the socioeconomic factors that contribute to the prevalence of liver disease in Hispanic and Latino people include environmental exposure to toxins, lower health literacy, less access to healthcare due to not having health insurance and other factors, bias and discrimination from health professionals, and language barriers.

Hispanic and Latino people with HCC have higher mortality rates. This may be because they are less likely to have their cancer diagnosed at an early stage. Biological differences can make the disease’s course more aggressive, rendering usual interventions less effective. The higher mortality rate may also be caused by systemic racism that reduces access to high-quality, timely care.

The high rate of liver cancer in Hispanic and Latino populations should be addressed through culturally-competent care, improving healthcare coverage, education programs, early screening and detection, and community outreach programs. These measures will help make liver cancer incidence, screening, diagnosis, treatment, and prognosis more equitable.