Liver cancer is among the leading causes of cancer death worldwide, and incidence and mortality are both expected to increase dramatically over the next decade and a half, according to an analysis published in the Journal of Hepatology.

“Liver cancer is a major cause of death in many countries, and the number of people diagnosed with liver cancer is predicted to rise,” wrote Harriet Rumgay, PhD, of the International Agency for Research on Cancer in France, and colleagues. “Efforts to reduce the incidence of preventable liver cancer should be prioritized.”

Over years or decades, hepatitis B, hepatitis C, fatty liver disease, heavy alcohol consumption, exposure to toxins and other causes can lead to serious liver damage, including cirrhosis and hepatocellular carcinoma, the most common type of primary liver cancer. It is often detected late, when it is more difficult to treat, resulting in high mortality.

The researchers analyzed the current global burden of liver cancer cases and deaths and predicted incidence (new cases) and mortality up to the year 2040. Using data from the World Health Organization International Agency for Research on Cancer’s GLOBOCAN 2020 database, they assessed liver cancer diagnoses and mortality across 185 countries. Based on this data as well as projections, they predicted incidence and death rates through 2040.

Around the world, some 905,700 people were diagnosed with liver cancer and 830,200 people died from it 2020. Globally, liver cancer was the sixth most common cancer diagnosis and the third most common cause of cancer-related death. It was the most frequently diagnosed type of cancer in six countries (Cambodia, Egypt, Laos, Mongolia, Thailand and Vietnam) and was among the top three in 18 countries. Liver cancer was the leading cause of cancer death in 15 counties and ranked among the top three causes in 46 countries and among the top five in 90 countries. Liver cancer incidence and death rates were higher for men than for women.

Global age-standardized incidence and mortality rates in 2020 were 9.5 and 8.7 per 100,000 people, respectively, but the rates varied substantially by region. Incidence and mortality rates were especially high in Eastern Asia (17.8 new cases and 16.1 deaths per 100,000 people)—which has a high burden of hepatitis B—followed by Northern Africa (15.2 new cases, 14.5 deaths) and Southeastern Asia (13.7 new cases, 13.2 deaths).

At the national level, liver cancer incidence rates were highest in Mongolia (85.6 cases per 100,000), Egypt (34.1 cases), Laos (24.2 cases) and Cambodia (24.3 cases). Reported incidence rates were lowest in Sri Lanka, Saint Lucia, Algeria and Botswana, all with 1.2 to 1.5 cases per 100,000. Mortality rates showed a similar pattern.

Given its large size, the United States had among the highest numbers of liver cancer diagnoses and deaths in 2020 (42,300 cases and 31,3000 deaths), exceeded only by China, India and Japan. But looking at population rates, it fell in the middle range, with 7.0 diagnoses and 4.7 deaths per 100,000.

The researchers predicted that between 2020 and 2040, the annual incidence of liver cancer would rise by 55%, with some 1.4 million people diagnosed in 2040. Similarly, the mortality rate was projected to rise by 56%, with 1.3 million people dying from liver cancer in 2040.

Worldwide, the causes of liver cancer are shifting, with fewer cases attributed to viral hepatitis but more cases related to fatty liver disease and heavy alcohol consumption. Fortunately, many cases of liver cancer can be prevented with hepatitis B vaccination and hepatitis C treatment. There is currently no effective approved treatment for non-alcoholic fatty liver disease and non-alcoholic steatohepatitis, so management relies on lifestyle changes such as weight loss and exercise.

“Primary liver cancer due to some causes is preventable if control efforts are prioritized, and the predicted rise in cases may increase the need for resources to manage care of patients with liver cancer,” the researchers wrote.

Click here to read the study in the Journal of Hepatology.

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