Liver cancer kills more than 700,000 people each year. However, three in five cases could be prevented, according to a comprehensive analysis published in the journal Lancet.
The research found that prevention could be accomplished by addressing the disease’s major causes – hepatitis B, hepatitis C, alcohol-associated liver disease and liver disease linked to metabolic risk factors such as obesity.
With nearly 900,000 new cases globally each year, liver cancer is the sixth most common cancer and the third leading cause of death from cancer. If cases continue to rise at the current rate, the number of new annual diagnoses will almost double, rising to 1.5 million globally in 2050, the study predicted.
There are two broad categories of liver cancer – primary liver cancer and metastatic (secondary) liver cancer. About 370 people are diagnosed with primary liver cancer each year in Ireland. It is twice as common in men than it is in women.
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The researchers estimated that liver disease from alcohol use and metabolic dysfunction together would account for nearly a third of new liver cancer cases by 2050. The findings align with what liver specialists have seen in their clinics for years.
“Liver cancer is common. It causes immense suffering and death, and the saddest part for me as a physician is that most of the cases are preventable,” said Dr Brian Lee, an associate professor of medicine, who was not involved in the study.
Improved screening, vaccination and treatment in recent years have helped stem viral hepatitis. But the threat of liver cancer from heavy alcohol use and metabolic dysfunction-associated steatotic liver disease, or MASLD, formerly known as nonalcoholic fatty liver disease, “has been underrecognised and underestimated,” said Dr Ahmed Kaseb, a professor of gastrointestinal medical oncology.
A vast majority of liver cancers arise in people with cirrhosis, says Dr Hashem El-Serag, chairman of the department of medicine at Baylor College of Medicine in Texas and one of the authors of the new study. Cirrhosis, or advanced and largely irreversible scarring of the liver, damages healthy tissue and prevents the organ from working normally.
The hepatitis B and C viruses cause inflammation that, if left untreated, can scar and damage the liver, potentially leading to cirrhosis. And both alcohol and metabolic dysfunction lead to abnormal deposits of fat in the liver, which can also result in inflammation.
Dr Lee says the accumulation of fat and inflammation acts as a “highway” to liver scarring, which in turn can injure DNA and lead to cancer. “There could be multiple ramps to get on to that highway,” he said.
The new paper found that the share of liver cancers resulting from hepatitis B and hepatitis C is expected to drop to 63 per cent in 2050, from 68 per cent in 2022. But the burden of liver cancers resulting from alcohol and MASLD is expected to grow.
An estimated four in 10 adults worldwide have MASLD, a condition in which fat builds up in the liver. Risk factors include obesity and Type 2 diabetes.
A subset of patients with MASLD will go on to develop an advanced form called metabolic dysfunction-associated steatohepatitis, or MASH, which has been described as a silent killer because it can progress to cirrhosis and liver cancer without being noticed.
Current guidance recommends monitoring for liver cancers in patients who have a history of viral hepatitis or established cirrhosis. Patients with MASH typically don’t meet that criteria, Dr Kaseb said, but they could have liver scarring without symptoms, and nobody would know.
That’s why screening for liver disease needs to begin at the primary care level, where cases can easily go undetected, said Dr Mary Rinella, a hepatologist at University of Chicago Medicine and the lead author of guidelines for the management of MASLD. She recommended that doctors use a metric called the Fib-4, which uses routine blood test results to estimate the amount of liver scarring, to screen high-risk patients. These include people who have Type 2 diabetes or obesity with at least one other metabolic risk factor, such as high cholesterol.
MASLD is reversible with lifestyle changes, including a healthy diet and increased exercise, and weight-loss drugs have recently been shown to be effective at reversing scarring as well. “If you stop the reason or the impetus for scarring and injury in the liver, then you’re going to have less impetus for the development of cancer,” says Dr Rinella.
There is no national liver cancer screening programme in Ireland, so it’s important to talk to your doctor about surveillance if you have a liver disease such as hepatitis B or C, genetic haemochromatosis or liver cirrhosis, as the risk of liver cancer is higher.
Alcohol-related liver disease is also on the rise. In research published in July, Dr Lee and his colleagues showed that the risk of alcohol-related liver disease among heavy drinkers (at least 10 drinks per week for women and 15 for men) in the United States more than doubled between 1999 and 2020, despite similar alcohol use over that period. That suggests that heavy drinkers today may be more sensitive to the effects of alcohol on the liver than those in the past, Dr Lee said.
In Ireland, while average alcohol consumption per adult has shown signs of falling, the incidence of binge drinking continues to be pronounced.
Drinking heavily and having a metabolic condition such as obesity can independently damage the liver, but patients who fall in both categories are at an especially high risk.
These trends are likely to continue.
“Alcohol use is increasing,” says Dr Rinella. “Obesity and diabetes are increasing.”
“I expect that we’re going to continue to see a high burden of liver disease,” she added. – This article originally appeared in the New York Times
