Three out of five liver cancer cases are preventable, study finds

Boston Globe

6 days ago

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The findings align with what liver specialists have seen in their clinics for years.
'Liver cancer is common, it causes immense suffering and death, and the saddest part for me as a physician is that most of the cases are preventable,' said Dr. Brian P. Lee, an associate professor of medicine at the Keck School of Medicine at the University of Southern California, who was not involved in the study.
Improved screening, vaccination and treatment in recent years have helped stem viral hepatitis, especially in the United States. But the threat of liver cancer from heavy alcohol use and metabolic dysfunction-associated steatotic liver disease, or MASLD, formerly known as nonalcoholic fatty liver disease, 'has been underrecognized and underestimated,' said Dr. Ahmed Kaseb, a professor of gastrointestinal medical oncology at the University of Texas MD Anderson Cancer Center, who was not associated with the study.
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A 'highway' to liver cancer
A vast majority of liver cancers arise in people with cirrhosis, said Dr. Hashem El-Serag, the chair of the department of medicine at Baylor College of Medicine in Texas and one of the authors of the new study. Cirrhosis, or advanced and largely irreversible scarring of the liver, damages healthy tissue and prevents the organ from working normally.
The hepatitis B and C viruses cause inflammation that, if left untreated, can scar and damage the liver, potentially leading to cirrhosis. And both alcohol and metabolic dysfunction lead to abnormal deposits of fat in the liver, which can also result in inflammation.
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Lee said the accumulation of fat and inflammation acted as a 'highway' to liver scarring, which in turn can injure DNA and lead to cancer.
'There could be multiple ramps to get onto that highway,' he said.
Why disease may go undetected
The new paper found that the share of liver cancers resulting from hepatitis B and hepatitis C is expected to drop to 63% in 2050, from 68% in 2022. But the burden of liver cancers resulting from alcohol and MASLD is expected to grow.
An estimated 4 in 10 adults worldwide have MASLD, a condition in which fat builds up in the liver. Risk factors include obesity and Type 2 diabetes.
A subset of patients with MASLD will go on to develop an advanced form called metabolic dysfunction-associated steatohepatitis, or MASH, which has been described as a silent killer because it can progress to cirrhosis and liver cancer without being noticed.
Current guidance recommends monitoring for liver cancers in patients who have a history of viral hepatitis or established cirrhosis. Patients with MASH typically don't meet that criteria, Kaseb said, but they could have liver scarring without symptoms, and nobody would know.
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That's why screening for liver disease needs to begin at the primary care level, where cases can easily go undetected, said Dr. Mary Rinella, a hepatologist at University of Chicago Medicine and the lead author of guidelines for the management of MASLD. She recommended that doctors use a metric called the Fib-4, which uses routine blood test results to estimate the amount of liver scarring, to screen high-risk patients. These include people who have Type 2 diabetes or obesity with at least one other metabolic risk factor, such as high cholesterol.
MASLD is reversible with lifestyle changes, including a healthy diet and increased exercise, and weight-loss drugs have recently been shown to be effective at reversing scarring as well.
'If you stop the reason or the impetus for scarring and injury in the liver, then you're going to have less impetus for the development of cancer,' Rinella said.
Alcohol compounds the problem
Alcohol-related liver disease is also on the rise. In research published this month, Lee and his colleagues showed that the risk of alcohol-related liver disease among heavy drinkers (at least 10 drinks per week for women and 15 for men) in the United States more than doubled between 1999 and 2020, despite similar alcohol use over that period. That suggests that heavy drinkers today may be more sensitive to the effects of alcohol on the liver than those in the past, Lee said.
This may be because the population of heavy drinkers is changing. The researchers found that women, who are more prone than men to develop fat and damage in the liver from alcohol, now make up a greater share of heavy drinkers than they did 20 years ago. So do people with metabolic syndrome, a cluster of metabolic disorders that together raise the risk of diabetes, heart disease and stroke — and compound the damage done by alcohol to the liver.
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Drinking heavily and having a metabolic condition such as obesity can independently damage the liver, but patients who fall in both categories are at an especially high risk.
These trends are likely to continue.
'Alcohol use is increasing,' Rinella said. 'Obesity and diabetes are increasing.'
'I expect that we're going to continue to see a high burden of liver disease,' she added.
This article originally appeared in
.