New Delhi, India – A significant new analysis from The Lancet Commission on liver cancer, published Monday, indicates that the majority of liver cancer cases are preventable. The report highlights that three in five liver cancer cases are attributed to modifiable risk factors, including metabolic dysfunction-associated steatotic liver disease (MASLD)—formerly known as non-alcoholic fatty liver disease—along with alcohol consumption and viral hepatitis. The Commission also underscores a worrisome trend: the increasing incidence of liver cancer cases linked to obesity.
Liver cancer is already a critical global health concern. It stands as the sixth most common cancer worldwide and is the third leading cause of death from cancer. Previous analyses have painted a grim picture, predicting that the number of new liver cancer cases could nearly double from 870,000 in 2022 to 1.52 million in 2050. This surge is primarily driven by global population growth and aging demographics, with Africa expected to see the largest increases. Correspondingly, the number of deaths from liver cancer is projected to climb from 760,000 in 2022 to 1.37 million in 2050.
“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% to 30%,” stated Prof. Jian Zhou of Fudan University in China. “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.”
The Commission’s findings emphasize a massive opportunity for prevention. “As three in five cases of liver cancer are linked to preventable risk factors, mostly viral hepatitis, alcohol and obesity, there is a huge opportunity for countries to target these risk factors, prevent cases of liver cancer and save lives,” said Stephen Chan, the first author from Chinese University of Hong Kong.
Shifting Landscape of Liver Cancer Causes
The Commission estimates that at least 60% of liver cancers are preventable through effective control of modifiable risk factors, including Hepatitis B virus (HBV), Hepatitis C virus (HCV), MASLD, and alcohol.
Notably, the report points to a significant shift in the dominant causes of liver cancer. The rate of MASLD-linked liver cancer is expected to rise sharply over the next decade, particularly in the US, Europe, and Asia, a direct consequence of increasing obesity rates. MASH (metabolic dysfunction-associated steatohepatitis), a severe form of MASLD, is now identified as the fastest-growing cause of liver cancer globally, followed closely by alcohol-related liver disease.
Projections indicate that the proportion of liver cancer cases associated with MASH is set to increase from 8% in 2022 to 11% in 2050, while alcohol-associated cases are projected to rise from 19% in 2022 to 21% in 2050.
In contrast, the proportion of liver cancer cases linked to HBV is expected to decrease from 39% in 2022 to 37% in 2050. Similarly, HCV-related cases are projected to drop from 29% to 26% over the same period, likely due to advancements in vaccination and treatment.
“Liver cancer was once thought to occur mainly in patients with viral hepatitis or alcohol-related liver disease,” explained Commission author Prof. Hashem B El-Serag from Baylor College of Medicine, US. “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.” Dr. Pramod Garg, head of gastroenterology at AIIMS, Delhi, further corroborated this, stating during a briefing on fatty liver that “It has been well-established that fatty liver can lead to life-threatening complications. There has been an an increase in cases, which is worrisome.”
Global Targets and Recommendations for Prevention
The Commission’s analysis provides a hopeful outlook: if countries can collectively reduce the incidence of liver cancer cases by 2% to 5% each year by 2050, it could prevent an astounding nine to 17 million new cases of liver cancer and save eight million to 15 million lives.
Beyond prevention, the authors stress the urgent need for increased research and attention to improve the quality of life for patients already living with liver cancer, as their numbers are steadily growing.
The Commission has put forth several key strategies to reduce the global burden of this deadly disease:
Governments must intensify efforts to increase HBV vaccination coverage and implement universal HBV screening for adults aged 18 and above.
Targeted HCV screening in high-risk areas should be prioritized based on cost-effectiveness.
Policymakers should enact measures such as minimum alcohol unit pricing, mandatory warning labels, and restrictions on alcoholic beverage advertisements.
National health authorities and cancer control programmes are urged to prioritize investments in public awareness campaigns and the deployment of early detection resources.
Professional organizations and the pharmaceutical industry should collaborate to bridge the disparities in clinical management of liver cancer between Eastern and Western regions of the world.
These recommendations underscore a comprehensive approach to tackling liver cancer, focusing on both primary prevention and improved patient care globally.
Majority Of Liver Cancer Cases Preventable, New Analysis Highlights Rising Obesity Link
