Liver cancer is among the top 3 causes of cancer deaths in 46 countries, and the number of new cases and related mortality is projected to rise steeply, according to a new global analysis published in the Journal of Hepatology.

The number of new cases of liver cancer is predicted to increase by 55% in the next 2 decades, with 1.4 million new diagnoses forecast for 2040. Additionally, an estimated 1.3 million deaths are predicted to occur by 2040, which will be an increase of 56.4%.

"Liver cancer causes a huge burden of disease globally each year," said senior author Isabelle Soerjomataram, MD, PhD, International Agency for Research on Cancer (IARC/WHO), Cancer Surveillance Branch, Lyon, France.

"It is also largely preventable if control efforts are prioritized — major risk factors include hepatitis B virus, hepatitis C virus, alcohol consumption, excess body weight, and metabolic conditions including type 2 diabetes," she added.

The authors emphasize that the global burden of liver cancer is substantial, as according to 2020 estimates, it is the sixth most commonly diagnosed cancer and the third most common cause of cancer deaths.

However, the burden varies across countries. For example, both incidence and mortality rates have declined in some Eastern Asian countries (including Japan, China, and the Republic of Korea), but at the same time, incidence and mortality rates have risen in countries previously considered low incidence, such as the United States, Australia, and some European countries.

Established risk factors for liver cancer include older age and male sex, and most cases are related to hepatitis, about 56% to hepatitis B virus (HBV) and 20% to hepatitis C virus (HCV). A further 18% may be related to tobacco smoking, whereas an estimated 17% may be attributable to alcohol drinking.

Differences in risk by ethnicity have also been reported. As an example, in multiethnic populations such as the United States, higher rates are seen among American Indians/Alaskan Natives, Hispanic persons, non-Hispanic Black persons, and Asians/Pacific Islanders as compared with non-Hispanic White persons.

Varies by nation, Human Development Index Status

Researchers identified data on primary liver cancer cases and deaths from the IARC's GLOBOCAN 2020 database, which produces cancer incidence and mortality estimates for 36 cancer types in 185 countries worldwide. The predicted change in cases or mortality by the year 2040 was estimated using population projections produced by the United Nations.

For 2020, an estimated 905,700 people were diagnosed with liver cancer and 830,200 individuals died from the disease. More than half of the cases (54.3%) and deaths (54.1%) occurred in Eastern Asia, which accounted for 21.5% of the world's population in 2020. China alone accounted for almost half of all liver cancer cases (45.3%) and liver cancer deaths (47.1%).

On a national level, liver cancer was the most commonly diagnosed cancer in 6 countries (Cambodia, Egypt, Laos, Mongolia, Thailand, and Vietnam) and also among the top 3 most commonly diagnosed cancers in a total of 18 countries.

For mortality, liver cancer was the most common cause of cancer-related death in 15 countries (Burkina Faso, Cambodia, Egypt, Gabon, the Gambia, Ghana, Guatemala, Laos, Mongolia, Nicaragua, Republic of Congo, Solomon Islands, Thailand, Vanuatu, and Vietnam) and also among the top 3 causes of cancer deaths in 46 countries.

Most of the countries with high incidences of liver cancer and related mortality were in eastern and southeastern Asia, northern and western Africa, and Central America.

However, liver cancer was also 1 of the top 5 causes of cancer mortality in several European countries (Bosnia and Herzegovina, France, Italy, Moldova, and Romania) and in Western Asia (Iran, Saudi Arabia, Turkmenistan, and Uzbekistan).

When looking at distribution using the UN's 4-tier Human Development Index (HDI), the largest percentage of both cases and deaths was in high HDI countries, accounting for 60.6% of new cases and 63.2% of deaths globally. This group also had the highest rates of incidence (14.0 new cases per 100,000 people) and mortality (13.3 deaths per 100,000 people). The authors note that this distribution was not unexpected as the high HDI group includes several of the nations with the highest rates of liver cancer incidence and mortality, such as Mongolia, Egypt, and China.

"We predicted that the number of people who are diagnosed with or die from liver cancer per year could increase by nearly 500,000 cases or deaths by 2040, unless we achieve a substantial decrease in liver cancer rates through primary prevention," commented Harriet Rumgay, BSc, lead author of the study. "These findings provide a snapshot of the global burden of liver cancer and are therefore an essential tool for countries to plan for liver cancer control."

Rumgay added that their latest predictions highlight the need to urgently reinforce current liver cancer prevention measures, "such as immunization, testing, and treatment for HBV infection and population-wide testing and treatment for HCV infection, as well as measures to reduce population alcohol consumption and curb the rise in the prevalence of diabetes and obesity, which can all have an impact in reducing the liver cancer burden."

No direct funding was received, and the authors report no relevant financial relationships.

A version of this article first appeared on Medscape.com, part of the Medscape Professional Network.

Liver cancer deaths to rise by more than 55% by 2040

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