The causes of liver cancer vary

The main drivers of liver cancer are changing globally, with fewer cases caused by viral hepatitis but more linked to non-alcoholic steatohepatitis (NASH) or heavy alcohol consumption, according to a new report published in Cell metabolism.

“Urgent action is needed globally to address the underlying metabolic risk factors and slow the growing burden of NASH-associated liver cancer, particularly in the Americas,” concludes the lead author. study Rohit Loomba, MD, of the University of California San Diego School of Medicine and colleagues.

Over the years or decades, hepatitis B or chronic hepatitis C, fatty liver disease (NASH and its less severe form, non-alcoholic fatty liver disease, or NAFLD), excessive alcohol consumption, and other causes Liver damage can lead to serious complications, including cirrhosis and hepatocellular carcinoma, the most common type of liver cancer.

Liver cancer is often diagnosed late and difficult to treat, making it one of the leading causes of cancer-related death worldwide and one of the fastest growing causes of cancer death in the United States. In 2020, more than 830,000 people worldwide and 30,000 people in the United States died from liver cancer.

Loomba’s team estimated global and regional trends in liver cancer burden and mortality as well as the contribution of various causes of liver disease using data from the Global Burden of Disease study.

In 2019, there were approximately 534,000 new cases of liver cancer and 485,000 deaths from liver cancer worldwide. This represents a 27% increase in liver cancer incidence and a 25% increase in mortality since 2010. After adjusting for age, global incidence and mortality rates have not not changed significantly, except for a substantial increase in the Americas.

The Western Pacific region (where hepatitis B is common) accounted for more than half of liver cancer deaths globally in 2019, but mortality remained stable compared to 2010. Adjusted liver cancer deaths in by age decreased in all other regions except one: mortality” in the Americas.

Liver cancer deaths related to hepatitis B and C worldwide have declined globally, thanks to widespread vaccination and treatment of hepatitis B virus (HBV) and the advent of direct-acting antiviral therapy effective that can cure hepatitis C virus (HCV).

But unlike all other regions, HBV-associated liver cancer deaths have increased in the Americas, “likely due to underdiagnosis and lack of awareness of the disease,” the authors suggested. the study. It was also the only region that did not experience a decline in HCV-associated liver cancer mortality, possibly due to “major gaps in diagnosis and linkage to care”.

Between 2010 and 2019, fatty liver disease and alcohol consumption accounted for an increasing share of liver cancer mortality. In fact, NASH has become the fastest age-adjusted cause of liver cancer death worldwide, particularly in the Americas, which the authors attribute to “rapidly rising rates of obesity.” . Another recent study found that NAFLD is the leading cause of liver cancer in older Americans covered by Medicare.

NAFLD and NASH are often accompanied by abdominal obesity, hypertension, high blood sugar, and abnormal blood lipid levels, collectively known as the metabolic syndrome. In the absence of effective approved medical therapies, disease management depends on lifestyle changes, such as weight loss and exercise.

Loomba and his colleagues projected that NASH-associated liver cancer would continue to rise over the next decade in the United States, Europe, and Asia. “Urgent action is needed globally to address the underlying metabolic risk factors and slow the growing burden of NASH-related liver cancer,” they wrote.

Alcohol consumption was the second fastest growing cause of liver cancer, again in the Americas. The authors noted that global alcohol consumption is expected to increase further, especially in the Western Pacific and Southeast Asia, which could lead to more cases of liver cancer in the future.

“Implementation of policies such as increased alcohol pricing and taxation can be considered at the national level to reduce the burden of alcohol-associated liver cancer in high alcohol consumption countries. per capita,” they suggested.

Click here to read the study Cell metabolism.

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