2 million, 19.8% of the total population in 2006 (31). Canadian census data show an increase in immigration from Africa and Asia made up about 17% of the foreign-born population in 1981, increasing to 28% in 1996 and 42% in 2001. Concurrently, immigrants from Europe made up a decreasing proportion of

the foreign-born population, beginning at 67% in 1981 and dropping to 55% in 1996 and then 42% in 2001 (28). Immigrants from high-risk areas for HBV infection showed elevated rates of Inhibitors,research,lifescience,medical several diseases including liver cancer (27),(29). The highest annual percentage change (APC) among 45–65 men liver cancer could be influenced by immigration from high-risk areas of hepatitis B infection. Previous epidemiological studies associated an increase in immigrants from high-risk areas with the rise in incidence and mortality of liver cancer in Canada (30),(32). Analysis by cultural background and region of birth revealed a high incidence of and mortality due to liver cancer for immigrants from certain specific regions. Chen et al. found that the risk of Inhibitors,research,lifescience,medical liver cancer was associated Inhibitors,research,lifescience,medical with a high proportion of immigration to the province of Ontario (28). Luo et al. examined

the incidence of cancer among Chinese immigrants in Alberta and found that the overall cancer incidence was lower among immigrants, but the incidence rates of liver cancer were much higher (16.7/100 000) than that among Canadian-born residents (1.7/100 000) of Alberta (32). The increased incidence rates of liver cancer observed in those studies were likely to be associated with the high prevalence of HBV and HCV infections among high-risk Inhibitors,research,lifescience,medical click here groups. Immigrants might have acquired such infection before coming to Canada. One study found increased risk among immigrants from South–Eastern Asia infected with biliary liver flukes where consumption of raw fresh-water fish

is a cultural practice. Biliary liver fluke has an infrequent cause of infection which the potential long-term consequences of chronic infection are highly associated with cholangiocarcinoma (33). Liver cancer is more prevalent in men than in women worldwide (1),(2). We observed a male Inhibitors,research,lifescience,medical to female ratio Oxygenase of around 2:1 for liver cancer incidence and mortality in Canada. We also observed that the increasing trends of incidence and mortality of liver cancer among men started at 45 years of age. The reasons for higher rates of liver cancer in males may be due to sex-specific differences in exposure to risk factors (27). Further, epidemiological studies have indicated that males are more sensitive to the effect of HBV infection than females. Wang et al. found that there was a greater risk difference between hepatitis B surface antigen carriers and noncarriers among males than among females, and that males had a significant synergistic effect for the interaction between sex and HBV infection on liver cancer mortality (34). A case-control study by Yu et al.