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The death rate for liver cancer increased by 43% since 2000, a new report from the CDC indicated, with fingers pointing to the obesity epidemic as the main root cause.

For adults 25 and over, mortality from liver cancer rose from 7.2 to 10.3 per 100,000 from 2000 to 2016, according to Jiaquan Xu, MD, of the CDC's National Center for Health Statistics in Hyattsville, Maryland, even as overall cancer mortality rates in the U.S. have dropped.

"Liver cancer (including intrahepatic bile duct cancer) was the ninth leading cause of cancer death in 2000 and rose to sixth in 2016," wrote Xu in an .

Among men, the age-adjusted death rate increased from 10.5 to 15.0 per 100,000 during this time period (a 43% rise); among women, the death rate increased from 4.5 to 6.3 per 100,000 (a 40% rise).

But while death rates increased for white (48%), black (43%), and Hispanic (27%) adults, the mortality rate among Asians and Pacific Islanders decreased by 22%.

Adults ages 45 to 54 saw a 20% drop in liver cancer death from 2012 to 2016 (from 5.5 to 4.4 per 100,000), while those ages 55 to 64 had stable rates from 2013 to 2016.

Commenting on the report, Ghassan Abou-Alfa, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City, cited non-alcoholic associated steatohepatitis (NASH) due to obesity and diabetes as the most important risk factor for hepatocellular carcinoma (HCC) in the U.S. today. "Unfortunately, the obesity epidemic is ongoing and is increasing, with a forecasted rate between 40% and 50% by 2030," he said.

Other risk factors for HCC include the hepatitis B and C viruses (HBV and HCV). "The novel and curative anti-viral therapy for HCV will hopefully and ultimately cause a reduction in incidence of HCV-related HCC," said Abou-Alfa. "However the per-patient cost remains elevated and is not necessarily accessible to all patients."

Research on screening for liver cancer due to various risk factors, including NASH, is ongoing, Abou-Alfa noted, and early diagnosis can lead to cure through surgery, radiofrequency ablation, and liver transplant. "Sadly this remains a limited option that is applicable for few patients," he said. "The importance of continued screening should be stressed to patients with HBV and HCV."

For the decade following the 2007 FDA approval of sorafenib (Nexavar) systemic treatment remained largely unchanged, but last year both regorafenib (Stivarga) and the immunotherapy nivolumab (Opdivo) received approval to treat the disease following studies that demonstrated survival improvements. "The advent of these novel systemic therapies will ensure that patient with systemic and unresectable disease are treated more promptly and appropriately," said Abou-Alfa.

Data from Xu's report were from the National Vital Statistics System. Along with analyses of age, sex, and race, the report also looked at areas with the highest rates of liver cancer mortality. At 16.8 per 100,000, the District of Columbia had the highest liver cancer mortality rate in 2016. States with the highest mortality rates were Louisiana (13.8 per 100,000), Hawaii (12.7), Mississippi (12.4), and New Mexico (12.4). Those with the lowest were Vermont (6.0 per 100,000), Maine (7.4), Montana (7.7), Utah (7.8), and Nebraska (7.8).