There’s a Dramatic Increase in Liver Cancer Death Rates Nationwide. Why?
The liver cancer death rate in the United States is up dramatically, according to a new report from the Centers for Disease Control and Prevention (CDC).
Roughly 22,000 men and 9,000 women in the nation develop liver cancer annually, the CDC says. How can we account for this increase? Who is most affected? What can be done to lower your risk?
For answers, we interviewed Einstein Healthcare Network hepatologist Richard Kalman, MD, who specializes in liver disease and transplantation, with a special interest in liver cancer.
Q: Liver cancer deaths are up 43 percent between 2000 and 2016, and deaths from liver cancer have moved from the ninth leading cause of cancer death to sixth. Is this new, or is it part of a longstanding trend?
A: This is unfortunately part of a trend over the last few years.
Q: How do we explain this increase?
A: The principal risk factor for liver cancer is underlying cirrhosis of the liver. As chronic liver disease and deaths from chronic liver disease continue to increase, so too has the rate of liver cancer. The most common risk factors for cirrhosis are viral hepatitis, obesity and alcohol abuse.
The epidemic of hepatitis C is finally being battled successfully with the advent of new effective antiviral therapies released over the last decade, but the number of individuals affected is quite staggering, especially in the baby boomer generation. As obesity continues to rise in this country, the incidence of liver disease related to obesity is also increasing. Alcohol-related liver disease is on the rise as well, and deaths related to this disease entity are rising dramatically in young individuals between 25 and 34 years of age.
Q: Men are reported to have a liver cancer death rate twice as high as women. Are there particular factors that might explain that large difference?
A: Men are more likely to develop liver cancer, and this is felt to be related to certain hormonal differences. In addition, risk factors for chronic liver disease may be higher in men versus women.
Q: Liver cancer deaths appear to be increasing across the board, in all racial and ethnic groups except Asians and Pacific Islanders. Has this always been the case, or is it something new?
A: The main risk factor for liver cancer in people from Asia is hepatitis B. Successful vaccine strategies have greatly reduced the incidence of this infection and standard screening protocols for liver cancer have improved mortality.
Q: Is one reason for higher liver cancer deaths the possibility that the disease has not been caught earlier? What are the survival rates if caught early?
A: Patients with early stage liver cancer have excellent survival rates, approaching 70 percent at five years after the initial diagnosis. Unfortunately, less than half of cases are diagnosed at an early stage and less than a third of patients are eligible for curative therapy. Patients at risk for liver cancer are asked to be screened with lab tests and liver ultrasound every six months, but the compliance with these recommendations is below 20 percent for a variety of reasons. If patients are screened with ultrasound and lab tests, liver cancer can be caught early when it is curable. It is important that patients with chronic liver disease see a liver specialist at least twice per year to make sure they can take advantage of these life saving strategies.
Q: How can people know whether they’re at risk? Is there a way to screen?
A: Unfortunately, patients with chronic liver disease may not present with symptoms until the disease is very far advanced. Therefore, it is essential that patients see their primary care provider regularly and if risk factors are present they should have screening blood tests.
It is also advised that all members of the baby boomer generation be screened with a one-time blood test to make sure they do not have hepatitis C virus exposure. Any patient with risk factors for viral hepatitis such as prior intravenous drug use, dialysis dependence, or blood transfusions before 1990 should be screened for infections, and patients with a personal history of obesity and a family history of liver disease should have routine blood work to make sure there are no liver abnormalities.
Q: What can people do to lower their risk?
A: Although liver disease and deaths related to liver disease and liver cancer are on the rise, there are certain risk factors for chronic liver disease that are modifiable. Patients with obesity, especially those with diabetes, can reduce their risk with weight loss, exercise, and optimal blood sugar control. Alcohol should be limited to less than three drinks per day for men and two drinks per day for women. Finally, if someone has risk factors for viruses such as hepatitis B and hepatitis C, they should be tested because treatment lowers the risk of cirrhosis and liver cancer.