Most liver cancer could be prevented through lifestyle changes and vaccination – study

Three in five liver cancer cases could be avoided through better hepatitis vaccination, reduced alcohol intake and efforts to tackle obesity, new research has found.

Without intervention, deaths from liver cancer are projected to rise from 760,000 in 2022 to 1.37m by 2050. The findings suggest 9m to 17m cases and 8m to 15m deaths could be prevented with targeted action.

The Lancet Commission on liver cancer found that reducing alcohol consumption, viral hepatitis B and C infections, and fatty liver disease could stop the majority of future cases.

Fatty liver disease occurs when excess fat builds up in the liver, which can lead to inflammation, liver damage and cancer.

Prof Jian Zhou of Fudan University in China, who led the research, said: “Liver cancer is a growing health issue around the world. It is one of the most challenging cancers to treat, with five-year survival rates ranging from approximately 5 per cent to 30 per cent.

“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.”

Liver cancer is the sixth most common cancer worldwide and the third leading cause of cancer death.

The number of new cases is expected to nearly double from 870,000 in 2022 to 1.52m in 2050, largely due to population growth and ageing, with the steepest increases expected in Africa.

More than 40 per cent of global cases currently occur in China, which has high rates of hepatitis B infection.

One of the fastest growing causes is fatty liver disease, now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), which is linked to obesity.

About one-third of the global population is thought to have MASLD, which may be prevented by eating a balanced diet, staying active and maintaining a healthy weight.

Only 20 to 30 per cent of people with MASLD go on to develop the more severe form, metabolic dysfunction-associated steatohepatitis (MASH), which can lead to liver cancer.

The commission said MASH-linked cases are projected to increase from 8 per cent of liver cancer cases in 2022 to 11 per cent in 2050.

Alcohol is the second fastest growing cause, with alcohol-related liver cancer cases expected to rise from 19 per cent to 21 per cent by 2050

In contrast, hepatitis B-related cases are projected to fall from 39 per cent to 37 per cent, while hepatitis C-related cases are expected to decline from 29 per cent to 26 per cent.

Prof Hashem B El-Serag of Baylor College of Medicine in the US said: “Liver cancer was once thought to occur mainly in patients with viral hepatitis or alcohol-related liver disease.

“However, today, rising rates of obesity are an increasing risk factor for liver cancer, primarily due to the increase in cases of excess fat around the liver.”

The commission recommended that governments expand HBV vaccination, implement universal screening for adults, introduce minimum alcohol pricing and sugar taxes, add warning labels to unhealthy products, invest in early detection of liver damage and cancer, and improve palliative care services.

Dr Matt Hoare, associate professor in hepatology at the University of Cambridge’s Early Cancer Institute, said liver cancer was “unlike many other cancers” in that its death rate is still rising.

He noted that causes vary by region, and said Japan had successfully reduced its death rate by introducing preventive measures and improving early detection.

His team is now working to identify which liver disease patients are most likely to develop cancer using DNA sequencing of the liver.