Globally, Liver Cancer Is Fourth Leading Cause of Cancer Death

The incidence of liver cancer grew by 75 percent between 1990 and 2015, according to the 2015 Global Burden of Disease study. While causes differ widely among different populations, most cases can be prevented through various interventions, such as vaccination, antiviral treatment, safe blood transfusion and injection practices, and reduction in excessive alcohol use, says the study.

Leading causes of liver cancer include hepatitis B (HBV) (33 percent), hepatitis C (HCV) (21 percent), and other: infection, alcohol use (16 percent). The global toll caused by these causes totals 20,578,000 disability-adjusted life years (DALYS) in the 195 countries and territories surveyed.

The goal of the study is to guide prevention efforts worldwide via primary prevention and secondary treatment.

Countries with Highest Burden. According to the sociodemographic index (SDI), 88 percent of liver cancer cases and 86 percent of liver cancer deaths occurred in middle-SDI, high-to-middle SDI, and high-SDI countries compared with low-middle SDI and low-SDI countries, with the highest burden in East Asia.

High-income Asia Pacific had the second most incident cases but only the third highest number of deaths, with Japan having 75 percent of cases, 67 percent of which were due to HCV.

Western Europe ranked third for liver cancer incident cases, fourth for deaths, and fifth for DALYS. Southeast Asia experienced the fourth highest number of incident cancer cases, but ranked second for liver cancer deaths and DALYs.

Where Does America Rank? High-income North America registered a 20 percent increase in liver cancer between 1990 and 2015, accounting for 37 percent of liver cancers due to alcohol use, 9 percent due to HBV, 31 percent due to HCV, and 23 percent due to other causes.

The increase is partially due to the high HCV prevalence among the Baby Boomers and associated injection drug use and transfusion of unsafe blood products. Causes due to alcohol and HBV also increased between 2005 and 2015, in part due to the burden of undiagnosed and untreated HBV infection in migrants from high–prevalence settings who had been infected since early childhood. HBV testing and treatment in these populations had not been widely adopted.

The Takeaway. Even with more successful primary prevention strategies, cases of liver cancer are likely to increase over the next decade due to aging populations and growth. Thus, secondary prevention is equally important. Study authors recommend that research on new treatment is urgently needed; sorafenib, to date, is the only approved drug, but it has modest survival benefits.

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