Liver cancer crisis looming as prevention lags, says Lancet report

A new report from The Lancet reveals that three out of five liver cancer cases worldwide are linked to preventable risk factors, with obesity-related cases on the rise.

The analysis, published on 29th July, estimates that over 60% of liver cancers could be avoided by addressing viral hepatitis, excessive alcohol consumption, and metabolic dysfunction-associated steatotic liver disease (MASLD), a condition driven by excess fat in the liver.

Without urgent intervention, the number of new liver cancer cases is projected to nearly double by 2050, reaching 1.52 million annually, with deaths rising from 760,000 to 1.37 million in the same period.

The situation is particularly urgent in Africa where liver cancer cases are projected to surge significantly by 2050.

The Lancet Commission on liver cancer warns that MASLD, particularly its severe form, metabolic dysfunction-associated steatohepatitis (MASH), is the fastest-growing cause of liver cancer, expected to increase by 35% by 2050.

One of the commissioning authors of the report, Professor Hashem El-Serag, a hepatologist at Baylor College of Medicine, believes liver cancer has a perception issue and isn't being taken seriously enough.

Rising obesity rates in the U.S., Europe, and Asia are fuelling this trend, with over 55% of U.S. adults predicted to develop MASLD by 2040.

The situation is similar in Africa where refined sugars and unhealthy diets are becoming increasingly common.

In Africa in particular Dr Kalebi believes there is less stigma around obesity and that a "pot belly" has cultural links with wealth and prosperity.

But he makes a link between diet and poverty and believes this is driving much of the rise.

He says: "Metabolic liver disease or metabolic symptoms in general is actually becoming a poor man's disease because the people who are poor are the most affected by poor diet because they are taking unhealthy foods. So unhealthy foods are actually becoming a bigger problem among the poor in the third world, in the rural areas because they are not aware. So somebody takes Fanta and Coke with bread for lunch, which is very unhealthy. It used to be seen that these kinds of foods are a sign of affluence, It used to be seen that a pot belly or weight is a sign of affluence, it is actually the other way round. We need to change that narrative."

Meanwhile, cases linked to hepatitis B and C are projected to decline slightly due to vaccination and treatment efforts.

The Commission calls for global action to curb preventable liver cancer, including expanded hepatitis B vaccination, stricter alcohol policies, and early screening for high-risk groups such as individuals with obesity and diabetes.

If countries reduce liver cancer incidence by 2-5% annually, up to 17 million cases and 15 million deaths could be prevented by 2050.

Professor Hashem El-Serag believes cases of Hepatitis B and C are what is causing the increased liver cancer rates in Africa and that screening and vaccination in the region is lagging behind the rest of the world.

However, he stresses obesity - as the continent becomes increasingly 'westernised' is also a major factor.

"Africa is also not immune to the obesity epidemic. With the progressive westernisation of their lifestyle and their diets. So they might be hit with multiple risk factors. A leftover from the old risk factors that really are not moving fast enough. And the emergence of the new risk factors that are happening as a result of globalization," he says.

Additional measures include public awareness campaigns, improved early detection, and better integration of palliative care for patients.

With liver cancer already the sixth most common cancer and third leading cause of cancer deaths worldwide, experts stress that targeted prevention strategies could significantly alter its trajectory.