GI cancer

Liver cancer: we haven’t seen the peak yet

Liver cancer cases around the world increased by 75% between 1990 and 2015, with high-income countries such as the US, Canada and Australia sharing in the burden.

The Global Burden of Disease study of primary liver cancer found associated mortality in Australia had increased by more than 20% during the study period.

Across high-income countries, hepatitis C accounted for about 40% of the contribution to mortality, followed by alcohol (30%) and hepatitis B (18%).

The study, comprising 195 countries or territories, identified 854,000 incident cases of liver cancer and 810,000 deaths contributing to 20,578,000 disability-adjusted life-years in 2015.

Globally, hepatitis B was the largest contributor to liver cancer deaths (33%) followed by alcohol (30%), hepatitis C (21%) and other causes (16%).

The male-to-female ratio for age-standardised liver cancer mortality was 2.8.

The findings reinforce the importance of hepatitis B vaccination, anti-viral treatment, safe blood transfusion and injection practices, and interventions to reduce excessive alcohol use.

But they will not be enough to prevent an increasing burden of disease.

“Even with successful primary prevention strategies, cases of liver cancer are likely to increase over the next decades owing to population aging and growth,” the study said.

Co-author of a related study on primary liver cancer Dr Paul Clark told the limbic clinicians had to step up by engaging with at-risk groups including migrants from hepatitis B endemic countries and older people who contracted hepatitis C as young adults.

“We need to recognise the disease and implement guidelines-based HCC screening – six monthly ultrasounds for patients at risk. It won’t prevent liver cancer but will identify it earlier when there is more treatment available including curative therapy.”

Dr Clark, a gastroenterologist and hepatologist from the University of Queensland, said screening was underdone due to a lack of awareness in the community and competing priorities for both patients and clinicians.

“As specialists, what we need to be doing is better supporting our GP colleagues so they can take on some of the role here and help improve outcomes for patients.”

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