Liver Cancer Has Doubled in High-Income Countries

New liver cancer cases and disease-related deaths have doubled since the early 1990s in many high-income countries, including the United States, Canada, Australia and the United Kingdom.

New findings show liver cancer is the only major cancer with rising mortality in these countries. According to Professor Dr. Morris Sherman of the Canadian Ministry of Health and University of Toronto Faculty of Medicine, many people encounter liver cancer in their 50s, while still actively working. Liver cancer symptoms generally arise at advanced stages, when treatment options are often disappointing, so preventing this cancer or diagnosing it early could save many more lives.

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Incidence and mortality show similar increases in women and men. In 2015, the United States, Australia and Canada had mortality per 100.000 of 7.5; England had mortality per 100.000 of 8.7.

The table belowshows rising liver cancer incidence over time in 4 developed countries. Numbers represent new annual diagnoses per 100 thousand people.

Reasons for rising incidence and mortality include hepatitis B and hepatitis C viral infections and obesity. In particular, the epidemic-like rise in obesitydrives increased nonalcoholic fatty liver disease, which may progress to liver cancer. 

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Even in high-income developed countries such as the United States, most people do not know they have hepatitis B or C until symptoms appear and diagnosis is made, often meaning a delayed, risky situation.

Effective but expensive antivirals exist for hepatitis C, but no preventive vaccine. Antiviral treatments for hepatitis B are relatively weaker, but an HBV vaccine provides complete protection and is administered from birth.

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Although hepatitis infection rates are not increasing, 3 reasons liver cancer incidence is rising

• aging among people already infected,
• increasing nonalcoholic fatty liver due to epidemic obesity
• alcohol consumption rates not declining

In early June 2018, the Canadian Association for the Study of the Liver published guidelines recommending hepatitis C testing for those born in 1945-1975. An estimated two-thirds to three-quarters of Canadians with hepatitis C were born in 1945-1975.

Among people infected with hepatitis C, %40 - 70 are unaware, because symptoms take years to appear. Screening even babies has therefore begun to be considered important, since infection duration also matters.

However, it is not correct to say that everyone infected with hepatitis B or C or with nonalcoholic fatty liver has a substantial liver cancer risk.

Screening everyone for early diagnosis can be difficult, but various risk scores can identify high-risk people. Cirrhosis is considered the most important factor, because it greatly increases liver cancer risk.

Patients diagnosed with cirrhosis enter a screening program with ultrasound every 6 months. Early-stage liver cancer can largely be treated.

Combating obesity and alcohol, and screening for hepatitis B and C, are prevention and early diagnosis strategies that may reduce future liver cancer rates.

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