Obesity-Linked Liver Cancer: Prevention & Rising Rates
Liver Cancer on the Rise: Experts Urge Global Action Amidst Shifting risk Factors
A landmark report highlights the growing threat of liver cancer, driven by the obesity epidemic and metabolic dysfunction, and calls for a multi-pronged global strategy to curb its rise.
The global burden of liver cancer is poised for a notable increase in the coming decade, a stark warning issued by a comprehensive commission report. While viral hepatitis and alcohol consumption have historically been the primary drivers, the escalating rates of obesity and its associated metabolic dysfunction, notably Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH), are emerging as critical new risk factors.
The report, published in The Lancet, emphasizes that the rise in MASLD-linked liver cancer is particularly concerning in regions like the US, Europe, and Asia, mirroring the trajectory of the global obesity epidemic. Projections suggest that by 2040, over 55% of US adults coudl be affected by MASLD.
“Liver cancer was once thought to occur mainly in patients with viral hepatitis or alcohol-related liver disease,” commented commission author Hashem B El-Serag, MD, Baylor College of Medicine, Houston. “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.”
In response to this evolving landscape, the commission has outlined ten key recommendations for a global action plan:
- Vaccination and Screening: Implementing Hepatitis B virus (HBV) vaccination into national immunization schedules and expanding targeted Hepatitis C virus (HCV) screening.
- Alcohol Reduction: Enforcing “strong government-led measures” to reduce alcohol consumption, including warning labels and advertisement restrictions.
- Environmental Controls: Addressing environmental risk factors, such as exposure to contaminated water and aflatoxins in food, especially in low- and middle-income countries.
- MASLD/MASH Preparedness: developing tailored national strategies for awareness, screening, and management of the anticipated increase in MASLD and MASH.
- public Awareness: Raising awareness of liver health among policymakers and the general population.
- Early HCC Detection: Improving early Hepatocellular Carcinoma (HCC) detection by optimizing surveillance tests and technologies.
- Standardized Diagnosis: Standardizing noninvasive diagnoses of HCC through consistent criteria for interpreting imaging studies.
- Global Clinical Management: Addressing East-West differences in clinical management through collaborative efforts between professional organizations and the pharmaceutical industry to achieve consensus and a clear action plan.
- HCC Survivorship: Enhancing HCC survivorship through research, clinical documentation of outcomes, complications, and treatment response, and integrating palliative care early for patients in need.
- Treatment Access: Facilitating access to HCV and HCC treatments, which are currently limited by high costs and a lack of demonstrated cost-effectiveness.
Dr. el-serag further advocated for integrating liver damage screening into routine healthcare for individuals at high risk for MASLD, including those with obesity, diabetes, and cardiovascular disease. He also stressed the importance of incorporating lifestyle counseling into routine care, encouraging healthy diets and regular physical activity. “Furthermore, policymakers must promote healthy food environments via policies such as sugar taxes and clear labelling on products with high fat, salt, and/or sugar,” he added.
The editorial board of The Lancet echoed these sentiments, concluding that the commission’s message of possibility-that strengthening prevention, fostering collaboration, and removing social and knowledge barriers can avert the rapid rise of liver cancer-is vital. “Taking action to realise that possibility is vital for the health of many millions of people worldwide over the next 25 years,” they stated.The commission’s work was supported by grants from the Natural Science Foundation of China,the Noncommunicable Chronic Diseases-National Science and technology Major Project,and the Shanghai Municipal Science and Technology Major Project.