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.

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.

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.

Last Reviewed January 2008

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