Global surge in liver cancer cases driven by obesity and MASLD, experts warn

New analysis suggests over three in five liver cancer cases globally are preventable through lifestyle changes, including reducing viral hepatitis exposure, alcohol, and metabolic dysfunction-associated steatotic liver disease (MASLD), a long-term liver condition caused by excess fat in the liver.

The analysis is part of The Lancet Commission on liver cancer, which suggests ways to reduce risk factors like public health policies that target obesity and alcohol consumption.

“Liver cancer is a growing health issue around the world. It is one of the most challenging cancers to treat, with five-year survival rates ranging from approximately 5% to 30%,” says the chair of the Commission and professor at Fudan University, China, Jian Zhou.

“We risk seeing close to a doubling of cases and deaths from liver cancer over the next quarter of a century without urgent action to reverse this trend.”

Alcohol and liver disease

Approximately a third of the global population are estimated to have MASLD, which was previously called non-alcoholic fatty liver disease. However, only 20–30% of patients with MASLD develop the advanced and more severe form of the condition with liver inflammation and damage, known as metabolic dysfunction-associated steatohepatitis (MASH).

MASH is the fastest growing cause of liver cancer globally, followed by alcohol, highlight the researchers. 

The Commission forecasts that the proportion of liver cancer cases linked to MASH will increase from 8% in 2022 to 11% in 2050 — a growth of 35%. Meanwhile, it forecasts liver cancer cases connected to alcohol consumption will rise from 19% in 2022 to 21% in 2050.

Conversely, it anticipates the proportion of liver cancer cases linked to the hepatitis B virus will drop from 39% in 2022 to 37% in 2050, while hepatitis C virus-related cases will fall from 29% to 26% over the same period.

MASH is the fastest growing cause of liver cancer globally, followed by alcohol, highlight the researchers.Obesity’s effects on liver health

Liver cancer was once thought to occur mainly in patients with viral hepatitis or alcohol-related liver disease. “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,” notes Commission author and professor at the Baylor College of Medicine, US, Hashem El-Serag.

In light of increasing obesity rates, the researchers project the rate of MASLD-linked liver cancer will rise over the next decade, most notably in the US, Europe, and Asia.

“As three in five cases of liver cancer are linked to preventable risk factors, mostly viral hepatitis, alcohol, and obesity, there is a huge opportunity for countries to target these risk factors, prevent cases of liver cancer, and save lives,” says first author, professor Stephen Chan, Chinese University of Hong Kong.

Regional trends

Without immediate intervention, the researchers project new liver cancer cases to nearly double from 870,000 in 2022 to 1.52 million in 2050, with Africa expected to see the largest increases. Related deaths are expected to rise from 760,000 to 1.37 million.

This surge is primarily driven by global population growth and aging.

Currently, liver cancer stands as the sixth most common cancer globally and the third leading cause of cancer death, with over 40% of cases occurring in China, primarily due to high rates of hepatitis B.

The authors call for increased public, medical, and political awareness of the rising risk of MASLD — especially in the US, Europe, and Asia — with a focus on high-risk groups, including individuals with diabetes and obesity.

In the US, MASLD prevalence continues to climb in parallel with the obesity epidemic; by 2040, over 55% of US adults could have MASLD.

“One approach to identify patients at high risk of liver cancer would be to introduce screening for liver damage into routine healthcare practice for patients at high risk of MASLD, such as individuals living with obesity, diabetes, and cardiovascular disease,” says El-Serag.

“Healthcare professionals should also integrate lifestyle counseling into routine care to support patients to transition to a healthy diet and regular physical activity. Furthermore, policy makers must promote healthy food environments via policies such as sugar taxes and clear labeling on products with high fat, salt, and/or sugar.”

Key intervention strategies

If countries can reduce liver cancer cases by 2–5% each year until 2050, the Commission estimates that they could prevent 9–17 million new liver cancer cases and save 8–15 million lives.

“Compared with other cancers, liver cancer is very hard to treat but has more distinct risk factors, which help define specific prevention strategies,” says Commission author, professor Valérie Paradis from Beaujon Hospital, France.

“With joint and continuous efforts, we believe many liver cancer cases can be prevented and both the survival and quality of patients with liver cancer will be considerably improved.”

The Commission suggests several key strategies. Firstly, it urges governments to intensify efforts to increase HBV vaccination, including mandates in high-prevalence countries, and implement universal HBV screening for adults aged 18 and over, alongside targeted HCV screening in high-risk areas. 

Policy makers are urged to enact minimum alcohol unit pricing, warning labels, and advertisement restrictions for alcoholic beverages.

Additionally, national health authorities and cancer control programs need to prioritize investments in public awareness campaigns and the deployment of early detection resources. The researchers also urge professional organizations and the pharmaceutical industry to collaborate on reducing differences in liver cancer clinical management between Eastern and Western regions of the world. 

Lastly, the researchers encourage hospitals and professional organizations to offer palliative care training with the aim of integrating palliative care early for patients in need.