Liver Cancer Cases Projected to Double, but Over Half Could Be Preventable

A new report has found that three in five liver cancer cases worldwide could be prevented by reducing alcohol consumption, levels of viral hepatitis, and MASLD, a long-term liver condition caused by excess fat in the liver.

The Lancet Commission on liver cancer urged policymakers to take action now to address the rising number of liver cancer cases. Without urgent action, the number of new liver cancer cases is predicted to double over the next 25 years, the report said.

As a way to reduce the risk factors for liver cancer, the Commission made several recommendations, including expanding hepatitis B vaccination coverage and developing public health policies focused on obesity and alcohol use.

According to the Commission, the recommendations could reduce the incidence of liver cancer cases by two to five percent each year, potentially preventing up to 18 million new cases and saving around 15 million lives over the next 25 years.

Liver cancer is the sixth most common cancer worldwide. Previous reports predict that, if no changes are made, the number of new cases could skyrocket from about 870,000 in 2022 to 1.52 million by 2050, primarily due to population growth and aging populations. Globally, the number of deaths from liver cancer is predicted to jump from 760,000 in 2022 to 1.37 million in 2050.

“Liver cancer is a growing health issue around the world,” Lancet Commission Chairman Jian Zhou, a professor at Fudan University in China, said in a news release. “It is one of the most challenging cancers to treat, with five-year survival rates ranging from approximately 5% to 30%. We risk seeing close to a doubling of cases and deaths from liver cancer over the next quarter of a century without urgent action to reverse this trend.”

Alcohol- and Obesity -Related Liver Cancers Expected to Rise; Viral Infection-Related Cases to Fall

The number of liver cancers due to alcohol and obesity is predicted to climb by 2050. According to the report:

• Liver cancers linked to obesity-related disease are predicted to rise from 8 percent to 10 percent by 2050, due to increasing rates of obesity, diabetes, high cholesterol, and other metabolic risk factors.

While alcohol and obesity are expected to increase rates, the number of cases caused by viral infections is predicted to drop, the report said. Viral infections such as hepatitis B and C are the leading causes of liver cancer.

Hepatitis B infections made up 39 percent of liver cancers in 2022; they are projected to drop to 36.9 percent by 2025, the report said. Additionally, hepatitis C made up 29.1 percent of liver cancers in 2022, but it is projected to decline to 25.9 percent in 25 years.

Lancet Report Shines Light on MASLD

The Commission estimates that at least 60 percent of liver cancers can be prevented once modifiable risk factors, including alcohol, hepatitis B virus, hepatitis C virus HCV, and MASLD (metabolic dysfunction-associated steatotic liver disease, previously known as non-alcoholic fatty liver disease), are addressed.

According to Dr. Hashem El-Serag, a co-author of the report and chair of the department of medicine at the Baylor College of Medicine in Houston, alcohol is generally viewed as the most significant risk factor for liver cancer, but MASLD is also a primary contributor.

“I think for most people, if you say cirrhosis, they immediately think of a relative, of someone who was a heavy drinker,” Dr. El-Serag told NBC News. “I think the vast majority do not make the tie between MASLD, or fatty liver, and cirrhosis and liver cancer.”

MASLD, caused by a buildup of fat in the liver, is predicted to increase in the USA, Europe, and Asia over the next 10 years due to rising obesity rates, according to the Commission’s report. MASLD affects about 25 percent of adults in the United States.

Although liver cancer makes up 21 percent of all new cancer cases in the United States, that figure could increase as the report estimates that U.S. rates of MASLD may affect more than 55 percent of adults by 2040.

All is not lost, however. Earlier detection and effective treatment plans for MASLD can reduce the risk of obesity-related liver cancer, according to Dr. El-Serag. The most common treatment is weight loss, while GLP-1 weight loss drugs, such as Ozempic and Wegovy, are promising, Dr. El-Serag told NBC News.

The Challenges of Screening for MASLD

Doctors say that screening for MASLD is challenging because it is not done as frequently as it is for other conditions, such as viral hepatitis.

What’s more, a person with cirrhosis may be screened for liver cancer, but people with MASLD can get liver cancer without developing cirrhosis. According to the commission report, up to 40 percent of people with liver cancers associated with MASLD don’t develop cirrhosis.

To make matters worse, it’s difficult to determine whether an individual has MASLD and/or MASH (metabolic dysfunction-associated steatohepatitis), a more severe form of MASLD, because these conditions often have no symptoms.

“Right now, it’s haphazard,” Dr. El-Serag told NBC News. “Some people get tested. Others get suspected. Third, who knows?”

Currently, patients are tested for MASLD and/or MASH if they have elevated liver enzymes in their blood, according to Dr. Arun Jesudian, a hepatologist and the director of liver quality and inpatient liver services at Weill Cornell Medicine and NewYork-Presbyterian.

Dr. El-Serag offered ways to identify patients at high risk for liver cancer:

• Healthcare professionals should incorporate lifestyle counseling into routine care to help their patients transition to a healthy diet and regular physical activity.

• Policymakers must promote healthy food environments through policies, such as sugar taxes and clear labeling on products with high levels of fat, salt, and/or sugar.

Dr. Jesudian recommends educating patients and doctors about MASLD to improve diagnosis and testing.

“I think then we need to make sure that providers who are interacting with these patients are looking at the liver disease component of metabolic syndrome,” Jesudian told NBC News, referring to patients with a group of conditions, including high blood sugar, high blood pressure, and excess weight. “So checking liver enzymes, that they know how to assess for fibrosis, even based on these blood test scores.”

Healthcare professionals agree that the earlier the detection of liver disease, the better the chances of preventing liver cancer.

“Ultimately,” Dr. Jesudian said, “treating these liver diseases early is the best way to prevent liver cancer, because liver cancer almost always occurs in the setting of chronic liver disease.”

Source Links:

https://www.yahoo.com/news/articles/liver-cancer-cases-projected-double-223106492.html?guccounter=1
https://www.eurekalert.org/news-releases/1092387