What is the prevalence of primary liver cancer?

Prevalence and Epidemiology of Primary Liver Cancer

Primary liver cancer is the fifth most common cancer worldwide and the second most frequent cause of cancer-related death globally, with hepatocellular carcinoma (HCC) accounting for approximately 90% of all primary liver cancers. 1

Global Burden and Distribution

The global burden of primary liver cancer is substantial:

• Approximately 854,000 new cases and 810,000 deaths occur annually, accounting for 7% of all cancers 1
• Incidence rates vary significantly by geographical region:
  • Highest in Eastern and South-Eastern Asia and Africa
  • Intermediate in Southern Europe
  • Lower in most high-income countries 2

In the United States, liver cancer incidence is steadily rising, showing the highest average annual percent increase among the top 15 cancers by incidence 1. Projections indicate that by 2030, liver cancer will become the third leading cause of cancer-related deaths in the US, surpassing breast, colorectal, and prostate cancers 1, 3.

Age and Gender Distribution

• HCC incidence increases progressively with age in all populations, typically reaching a peak at 70 years 1
• The disease affects men more frequently than women 2
• Recent trends show patients presenting at increasingly younger ages, partly due to the rising prevalence of non-alcoholic fatty liver disease (NAFLD) 1

Risk Factors and Etiology

Approximately 90% of HCCs are associated with known underlying risk factors:

1. Viral Hepatitis:

   • Hepatitis B virus (HBV): Accounts for approximately 54% of cases globally
   • Hepatitis C virus (HCV): Accounts for approximately 31% of cases globally 1
   • Regional variations exist: HBV is responsible for 60% of cases in Africa and East Asia, while HCV is the predominant risk factor in Western countries 1

2. Cirrhosis:

   • Present in approximately 80% of HCC cases
   • One-third of cirrhotic patients will develop HCC during their lifetime
   • Annual HCC development rates in cirrhotic patients: 1-8% overall, 2% in HBV-related cirrhosis, and 3-8% in HCV-related cirrhosis 1

3. Other Risk Factors:

   • Chronic alcohol abuse
   • Aflatoxin exposure (particularly important in Africa and Eastern Asia)
   • Non-alcoholic fatty liver disease/metabolic syndrome
   • Genetic hemochromatosis
   • Alpha-1-antitrypsin deficiency 1, 2

Non-Cirrhotic HCC

While cirrhosis is the predominant risk factor, approximately 20% of HCC cases develop in non-cirrhotic livers 4. This subgroup typically presents at more advanced stages due to:

• Lack of surveillance in non-cirrhotic patients
• Clinical silence in early stages
• Higher hepatic reserve in this population 4

Regional Variations in Europe

The distribution of primary liver cancer varies significantly across European countries:

• Highest numbers in Italy (10,733 cases), Germany (9,202), France (8,332), and Russia (6,812)
• Moderate numbers in Spain (5,522) and the UK (4,186)
• Lower numbers in smaller countries like Norway (190), Lithuania (175), and Latvia (154) 1

Changing Trends

Some regions are experiencing changing trends in HCC incidence:

• Japan has noted a decline in HCC incidence for the first time since 1990, likely due to effective management of HCV-related liver disease 1
• Universal infant vaccination against HBV has decreased HBV-related HCC rates in endemic countries, particularly among children and younger adults in Taiwan 1

Prevention Strategies

Given the strong association between chronic liver disease and HCC, prevention strategies focus on:

• Vaccination against hepatitis B for all newborns and high-risk groups
• Antiviral therapies for chronic hepatitis B and C
• Policies to prevent HCV/HBV transmission
• Measures to counteract chronic alcohol abuse
• Lifestyle modifications to prevent obesity and metabolic syndrome
• Coffee consumption, which has been shown to decrease HCC risk in patients with chronic liver disease 1

Understanding the epidemiology of primary liver cancer is crucial for developing effective screening, surveillance, and treatment strategies to reduce the global burden of this highly lethal malignancy.