Chapter 10: Cancer of the Bile Ducts

The Burden of Digestive Diseases in the United States

James E. Everhart, M.D., M.P.H.

For this report, intrahepatic and extrahepatic bile duct cancers were combined (see Appendix 1 for ICD-9 and ICD-10 codes). Substantial differences between them are noted.

In 2004, 22 percent of bile duct cancer was coded intrahepatic and 45 percent extrahepatic; nearly all the remainder did not have a location specified. Rates were much higher in the oldest age group, with 74 percent of cases occurring at age 65 or older. Age-adjusted rates were highest among Hispanics and Asians (Table 1). Males had a higher rate and slightly higher number of cases than females. Incidence increased modestly between 1979 and 2004 (about 22 percent), all of which could be accounted for by an increase in the incidence of intrahepatic bile duct cancer. Five-year survival did not improve and was about 10 percent for the entire period (Figure 1). There were too few outpatient or inpatient diagnoses to draw inferences about medical care (Table 2), but hospitalization rates were relatively constant at about 5 per 100,000 U.S. population (Figure 2).

Because of low survival, bile duct cancer mortality was similar to incidence. As underlying cause, there were 4,954 deaths in 2004 and nearly 33,000 YPLL prior to age 75 years (Table 3). Rates were highest in the oldest age group. Age-adjusted mortality rates were slightly higher for whites and for males. Death rates for bile duct cancer rose 39 percent between 1979 and 2004 (Figure 3).

Table 1. Bile Duct Cancer: Number of Cases and Incidence Rate by Age, Race/Ethnicity, and Sex, 2004

Source: Surveillance, Epidemiology, and End Results (SEER) Program

Demographic Characteristics Number of Cases Incidence per 100,000 Unadjusted Incidence per 100,000 Age-Adjusted
AGE (Years)
Under 15
AGE (Years)
15–44
266 0.2
AGE (Years)
45–64
1,655 2.4
AGE (Years)
65+
4,569 13.4
RACE/ETHNICITY
Non-Hispanic White
4,859 2.5 2.1
RACE/ETHNICITY
Non-Hispanic Black
523 1.5 2.1
RACE/ETHNICITY
Hispanic
519 1.3 2.8
RACE/ETHNICITY
Asian/Pacific Islander
332 2.7 3.3
RACE/ETHNICITY
American Indian/Alaska Native
Sex
Female
3,051 2.1 2.0
Sex
Male
3,133 2.2 2.7
Total 6,186 2.2

Figure 1. Bile Duct Cancer: Age-Adjusted Incidence Rates and 5-Year Survival Rates, 1979–2004

Incidence per 100,000 increased from 1.85 in 1979 to 2.27 in 2004. Five-year survival was around 10 percent for the entire period through 1999, the last year for which it could be calculated.
Source: Surveillance, Epidemiology, and End Results (SEER) Program

Table 2. Bile Duct Cancer: Number and Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With First-Listed and All-Listed Diagnoses by Age, Race, and Sex in the United States, 2004

Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (3-year average, 2003–2005), and Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP NIS

Demographic Characteristics Ambulatory Care Visits First-Listed Diagnosis Number in Thousands Ambulatory Care Visits First-Listed Diagnosis Rate per 100,000 Ambulatory Care Visits All-Listed Diagnosis Number in Thousands Ambulatory Care Visits All-Listed Diagnosis Rate per 100,000 Hospital Discharges First-Listed Diagnosis Number in Thousands Hospital Discharges First-Listed Diagnosis Rate per 100,000 Hospital Discharges All-Listed Diagnosis Number in Thousands Hospital Discharges All-Listed Diagnosis Rate per 100,000
AGE (Years)
Under 15
AGE (Years)
15–44
0 0 1 1
AGE (Years)
45–64
2 3 5 7
AGE (Years)
65+
6 17 11 30
Race
White
7 3 14 5
Race
Black
1 3 1 5
Sex
Female
4 3 8 5
Sex
Male
5 4 9 7
Total 9 3 17 6

Figure 2. Bile Duct Cancer: Age-Adjusted Rates of Ambulatory Care Visits and Hospital Discharges With All–Listed Diagnoses in the United States, 1979–2004 (Ambulatory Care Visit Data Unavailable)

The number of ambulatory care visits during the period was too small to provide estimates. Hospitalization rates during the period were relatively constant at about 5 per 100,000.
Source: National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) (averages 1992–1993, 1994–1996, 1997–1999, 2000–2002, 2003–2005), and National Hospital Discharge Survey (NHDS)

Table 3. Bile Duct Cancer: Number and Age-Adjusted Rates of Deaths and Years of Potential Life Lost (to Age 75) by Age, Race, and Sex in the United States, 2004

Source: Vital Statistics of the United States

Demographic Characteristics Underlying Cause Number of Deaths Underlying Cause Rate per 100,000 Underlying Cause Years of Potential Life Lost in Thousands Underlying or Other Cause Number of Deaths Underlying or Other Cause Rate per 100,000
AGE (Years)
Under 15
2 0.0 0.1 3 0.0
AGE (Years)
15–44
143 0.1 5.2 148 0.1
AGE (Years)
45–64
1,245 1.8 21.9 1,308 1.9
AGE (Years)
65+
3,564 9.8 5.7 3,855 10.6
Race
White
4,348 1.7 27.6 4,657 1.8
Race
Black
366 1.4 3.4 401 1.5
Sex
Female
2,554 1.5 15.1 2,711 1.6
Sex
Male
2,400 1.9 17.8 2,603 2.1
Total 4,954 1.7 32.9 5,314 1.8

Figure 3. Bile Duct Cancer: Age-Adjusted Rates of Death in the United States, 1979–2004

Death rates rose between 1979 and 2004. Underlying-cause mortality per 100,000 increased from 1.18 in 1979 to 1.64 in 2004. All-cause mortality per 100,000 increased from 1.33 in 1979 to 1.76 in 2004.
Source: Vital Statistics of the United States
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