September 2025
Action needed to stop the rising burden of new liver cancer cases
By Rebecca Jenkins
At least 60% of liver cancers globally could be prevented by controlling modifiable risk factors such as viral hepatitis, alcohol use and obesity, a Lancet Commission reports.
Liver cancer was the sixth most common cancer globally, with the case rate predicted to double from 870,000 in 2022 to 1.52 million in 2050, according to an expert group of clinical and public health practitioners tasked with addressing the rising burden of the disease.
As part of its analysis, the Commission found that an annual reduction of at least 2% in the age-standardised incidence rate (ASIR) was needed to stop the rising burden of new cases of liver cancer, with a targeted 5% reduction recommended for regions already making progress.
‘If an annual 2–5% reduction in ASIR is achieved over the next 25 years, we estimate 8.8–17.3 million new cases of liver cancer could be prevented, and 7.7–15.1 million lives could be saved,’ the Commission reported.
Hepatitis B would remain the leading cause of liver cancer, but the proportion of hepatitis B virus-related liver cancer would decrease from 39% in 2022 to 36.9% in 2050 and the proportion of hepatitis C virus-related liver cancer would also decline from 29.1% to 25.9%.
However, the proportion of liver cancer cases associated with a severe form of metabolic dysfunction-associated steatotic liver disease (MASLD) known as metabolic dysfunction-associated steatohepatitis (MASH) was projected to increase from 8% in 2022 to 10.8% in 2050.
In addition, liver cancer cases associated with alcohol were projected to increase from 18.8% in 2022 to 21.1% in 2050, the Commission’s analysis found.
Commenting on the report, Professor Simone Strasser, Head of Department at the AW Morrow Gastroenterology and Liver Centre, and Co-Director of the Australian National Liver Transplant Unit at Royal Prince Alfred Hospital and The University of Sydney, noted that the incidence of liver cancer in Australia mirrored the trends shown in the report with an increase over the past two to three decades, despite a decline in the contribution of viral hepatitis.
‘This is related to the progressive increase in liver cancer related to nonviral causes, particularly alcohol-related liver disease and MASLD – which in Australia, was referred to by consensus as metabolic dysfunction-associated fatty liver disease (MAFLD),’ she told Medicine Today.
‘The increasing contribution of MAFLD as a cause of liver cancer is strongly associated with the rise in obesity and type 2 diabetes in the population.’
Professor Strasser noted that a diagnosis of MAFLD could be made by the presence of fatty liver, associated with either type 2 diabetes or overweight/obesity or with two metabolic risk factors in people of normal body weight without diabetes.
The Gastroenterological Society of Australia and the Australian Diabetes Society strongly recommended that all patients with diabetes were assessed for MAFLD and that all people with MAFLD aged over 35 years had assessment of a Fibrosis-4 (FIB-4) score (using age, aspartate transferase and alanine transaminase levels and platelet count), she noted.
GPs had a major role in identifying risk factors for liver disease, Professor Strasser added, noting opportunities to test people at high risk for viral hepatitis or if there was evidence of liver disease, and to screen for harmful alcohol use through medical history and an Alcohol Use Disorders Identification Test (AUDIT-C) questionnaire.