At Least 60% of Liver Cancers Tied to Preventable Risk Factors

 

• The global incidence of liver cancer is projected to double by 2050.
• Sixty percent of liver cancers are preventable by controlling risk factors including hepatitis B and C, alcohol consumption, and MASLD.
• The Lancet Commission estimated that a 2-5% reduction in the age-standardized incidence rate of liver cancer could prevent up to 17.3 million new cases, and save up to 15.1 million lives.

At least 60% of liver cancers globally could be prevented with control of certain risk factors, including viral hepatitis, alcohol use, and metabolic dysfunction-associated steatotic liver disease (MASLD), according to an analysis from the Lancet Commission.

In order to reverse the trend of a rising liver cancer burden, an annual reduction of at least 2% in the age-standardized incidence rate is required, while a 5% reduction could prevent up to 17.3 million new cases and save up to 15.1 million lives over the next 25 years, the commission reported.

According to projections, if current trends don't change, the number of new liver cancer cases globally will jump from 870,000 in 2022 to 1.52 million in 2050, while the number of deaths from liver cancer will increase from 760,000 to 1.37 million, noted Jian Zhou, MD, PhD, of Zhongshan Hospital and Fudan University in Shanghai, and fellow commission members in The Lancetopens in a new tab or window.

The age-standardized incidence rates of liver cancer are rising, with increases of 1.0% and 2.8% per year in Europe and North America, respectively, largely driven by increases in MASLD and alcohol-associated liver disease. Africa is expected to see the most dramatic increase in cases of liver cancer and associated deaths due to rapid population growth and a high prevalence of hepatitis B and C virus (HBV/HCV).

"These troubling global trends underscore the urgent need for coordinated international efforts to stem the rise in liver cancer," Lancet editors wrote in an accompanying editorialopens in a new tab or window.

According to the commission's analysis, the causes of hepatocellular carcinoma (HCC) are projected to change from 2022 to 2050. HBV will remain the leading cause, although the proportion of HBV-related liver cancers will decrease from 39% to 36.9%. The proportion of HCV-related liver cancers will decline from 29.1% to 25.9%.

At the same time, alcohol-related HCC will increase from 18.8% to 21.1%, and metabolic dysfunction-associated steatohepatitis (MASH) will increase from 8.0% to 10.8%.

"Liver cancer is highly preventable, and prevention is way better than diagnosis and treatment," co-author Hashem B. El-Serag, MD, MPH, of the Baylor College of Medicine in Houston, told MedPage Today. "Most of the risk factors are known, established, and diagnosable. Find them, link them to care, and treat them."

With this in mind, the commission came up with a number of recommendations for reducing the burden of liver cancer, with prevention as the foundation. These preventive strategies include:

• Universal HBV vaccination
• Universal screening and treatment for HBV and HCV
• Reducing alcohol consumption
• Preparing for the increase in MASLD and MASH

Regarding the applicability of these risk factors to the U.S., El-Serag noted that HCV has been the dominant risk factor for liver cancer in the U.S.

"It is the reason why the incidence of liver cancer has tripled over the last 40 years or so," he said. "Fortunately, over the past few years, the rates of liver cancer have plateaued, and that is primarily due to efforts related to screening and treatment of hepatitis C, which now has a curative treatment. So, proceeding toward hepatitis C elimination in the U.S. is the most concrete, useful step to further reduce the risk of liver cancer."

He added that while HBV is less prevalent in the U.S., the CDC has recommended screening all adults for the disease -- recommendations "not very well implemented throughout the country, and doubling down on screening and linkage to care, and treatment when appropriate, would be very relevant for the U.S."

As for alcohol consumption, El-Serag pointed out that alcohol-associated liver disease probably contributes to about one-third of cases of cirrhosis leading to liver cancer in the U.S.

"Therefore, measures related to the reduction of alcohol, education about the harms of alcohol, and in a more tangible way, screening in clinical practice for presence of alcohol-associated liver disease and intensified treatment and counsel is an important measure," he added.

Finally, MASLD is very relevant to the U.S. population, El-Serag said, "but is going to be very difficult to tackle."

About a quarter of all adults in the country have MASLD, with a smaller proportion progressing to advanced liver disease and cirrhosis.

"MASLD is strongly intertwined with the epidemic of obesity and type 2 diabetes," El-Serag observed, adding that, in the U.S., the objective should be to increase awareness of MASLD as an established risk factor for liver cancer, boost screening for it in primary care, identify subgroups who are likely to advance to liver cancer, and offer intensified treatment for those subgroups.

On a global level, the Lancet Commission noted that preventive measures like these are often undermined by limited access to and poor awareness of these measures, and government-led approaches are needed to coordinate efforts to overcome these barriers.

The commission also recommended that action is needed to improve the uptake of surveillance for HCC in order to improve early detection. For example, they urged institutions and diagnostics developers to scale up non-invasive screening technologies, such as blood-based biomarkers and point-of-care testing, to improve the efficiency of screening.

Regarding treatment, the commission observed that advances in HCC treatment have improved patient survivorship, and "enhancing survivorship should be a key focus of future research."

Finally, disparities in access to prevention, surveillance, and treatment of HCC need to be reduced, if not eliminated, they noted.

"Because social inequalities permeate all stages of the hepatocellular carcinoma care continuum (from prevention to end-of-life care), prevention remains the most effective approach to reducing hepatocellular carcinoma disparities globally," they wrote.

Disclosures

Zhou reported relationships with AstraZeneca, MSD, the Asia-Pacific Primary Liver Cancer Expert Association, the Asian Pacific Association for the Study of the Liver, the Beijing Life Oasis Public Service Center, the Beijing Medical Award Foundation, the Chronic Disease Prevention and Treatment of Traditional Chinese Medicine Promotion Association, the Beijing Health Alliance Charitable Foundation, the Chinese Society of Oncology, the Chinese Medical Association, and Chinese College of Surgeons.

El-Serag had no disclosures

Multiple co-authors also reported relationships with industry.

Primary Source

The Lancet

Source Reference: opens in a new tab or windowChan SL, et al "The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment" Lancet 2025; DOI: 10.1016/S0140-6736(25)01042-6.

Secondary Source

The Lancet

Source Reference: opens in a new tab or windowThe Lancet "Reversing the rise of liver cancer" Lancet 2025; DOI: 10.1016/S0140-6736(25)01530-2.

https://www.medpagetoday.com/gastroenterology/generalhepatology/116711