Obesity-linked Liver Cancer Preventable, but Rising

At least 60% of liver cancers globally are preventable through risk-factor reduction, including obesity-linked metabolic dysfunction-associated steatotic liver disease (MASLD) and cases caused by viral hepatitis or alcohol consumption.

That’s a key message from a new Lancet Commission report on addressing the global hepatocellular carcinoma (HCC) burden, published online on July 28 to coincide with World Hepatitis Day.

The burden of new liver cancer cases is projected to increase to 1.52 million, and liver cancer-related deaths are projected to increase to 1.37 million by 2050, the commission pointed out.

In addition, the share of liver cancer cases caused by metabolic dysfunction-associated steatohepatitis (MASH), a severe form of MASLD, is expected to increase by 35% (8%-11%) by 2050.

The commission called for increased public, medical, and political awareness of the rising risk for MASLD — especially in the US, Europe, and Asia — with a focus on high-risk groups, such as those with diabetes and/or obesity.

With the number of new liver cancer cases predicted to double over the next 25 years without urgent action, the Commission set a target for an annual reduction of 2%-5% in the number of new cases. This could prevent up to 17 million liver cancer cases and up to 15 million deaths, if achieved.

10 Recommendations

Overall, the commission suggested 10 strategies for reducing the global burden of liver cancer and improving patients’ quality of life. These include:

1. Strengthening viral hepatitis prevention, screening, and treatment, including integrating hepatitis B virus vaccination into national immunization schedules and targeted hepatitis C virus (HCV) screening.

2. Reducing alcohol consumption using “strong government-led measures,” such as warning labels and advertisement restrictions.

3. Controlling environmental risk factors, especially exposure to contaminated water and aflatoxins in food in low- and middle-income countries.

4. Preparing for the increase in MASLD and MASH with tailored national strategies for awareness, screening, and management.

5. Raising awareness of liver health among policy makers and the general population.

6. Improving early HCC detection by optimizing the performance of surveillance tests and technologies.

7. Standardizing noninvasive diagnoses of HCC with standardized criteria for interpreting imaging studies.

8. Addressing East-West differences in clinical management through collaborative efforts of professional organizations and the pharmaceutical industry to achieve consensus and a clear action plan.

9. Improving HCC survivorship through research, clinical documentation of outcomes, complications and treatment response, and integration of palliative care in the early phases for patients in need.

10. Facilitating access to treatment for HCV and HCC, which currently is limited mainly due to high cost and lack of cost-effectiveness.

Zeroing in on Obesity

The rate of MASLD-linked liver cancer is expected to rise over the next decade, particularly in the US, Europe, and Asia, due to increasing rates of obesity, the report authors warned.

In the US, MASLD prevalence continues to climb in parallel with the obesity epidemic; by 2040, over 55% of US adults could have MASLD, the commission predicted.

“Liver cancer was once thought to occur mainly in patients with viral hepatitis or alcohol-related liver disease,” commission author Hashem B El-Serag, MD, Baylor College of Medicine, Houston, commented in a press release. “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.” 

El-Serag suggested including screening for liver damage into routine healthcare practice for patients at high risk for MASLD, such as individuals living with obesity, diabetes, and cardiovascular disease. “Healthcare professionals should also integrate lifestyle counselling into routine care to support patients to transition to a healthy diet and regular physical activity,” he said. “Furthermore, policy makers must promote healthy food environments via policies such as sugar taxes and clear labelling on products with high fat, salt, and/or sugar.”

In a related editorial, The Lancet editorial board concluded, “The message of the Commission — that strengthening prevention, fostering collaboration, and removing social and knowledge barriers can help avert the rapid rise of liver cancer — is one of possibility. Taking action to realize that possibility is vital for the health of many millions of people worldwide over the next 25 years.”

The Commission was supported by grants from the Natural Science Foundation of China, Noncommunicable Chronic Diseases-National Science and Technology Major Project, and Shanghai Municipal Science and Technology Major Project. A list of authors with competing interests is available in the report.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.