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Intrahepatic cholangiocarcinoma (iCCA) is an often-fatal malignancy, with an annual incidence rate that closely approximates the mortality rate (1,2). The poor prognosis of these cancers is due in part to their nonspecific clinical presentation and the often-late stage at diagnosis—which is not amenable to curative treatment. While understanding the underlying biology of iCCA is important for early detection and therapy development, there is also a need to ascertain the temporal trends of the disease incidence and mortality. A thorough appraisal of trends in iCCA incidence and mortality would inform strategies for the prevention and identification of high-risk populations for screening and surveillance. Many studies have shown that the incidence and mortality rates of iCCA have increased in the US over the last few decades (1-6), but while some of these studies suggest that the increase in iCCA incidence appears to have plateaued (2,5), others show continuous rise of both the incidence and mortality of iCCA in the US (3,4,6).