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Q & A: Steve Lidofsky, MD, PhD on preventing liver cancer

March 24, 2023 by Kate Strotmeyer

By 2030 liver cancer is projected to be third highest cause of cancer-related death in the US. Despite the limited number of options at the time of diagnosis, liver cancer is preventable if the disorders from which it emerges are treated at an earlier stage.

Steve Lidofsky, MD, PhD and colleague's public health commentary in Hepatology advocates the recognition of these disorders--metabolic syndrome-associated fatty liver disease, alcohol-associated liver disease, and viral hepatitis--is critical to the elimination of liver cancer as a public health threat.

We asked Dr. Lidofsky for his thoughts: 

UVMCC: Who is most at risk of liver cancer?

SL: The populations at greatest risk are individuals with cirrhosis or with longstanding hepatitis B infection and no cirrhosis.

UVMCC: Are there ways to prevent liver cancer?

SL: The best way to prevent liver cancer is to prevent progression to cirrhosis from conditions in which it can develop - primarily fatty liver disease, alcohol-associated liver disease, and viral hepatitis.  Lifestyle measures, such as weight management and limitation of alcohol intake, are effective preventative strategies for fatty liver disease and alcohol-associated liver disease.  Hepatitis B infection is prevented by vaccination, and there are well-tolerated curative treatments for hepatitis C.

UVMCC: How is the incidence rate changing for each of the risk factors – viral hepatitis, alcohol-associated liver disease, and fatty liver disease?

SL: The incidence of liver cancer in viral hepatitis appears to have plateaued (and may be falling with hepatitis C in particular), while its incidence continues to increase in fatty liver disease and alcohol-associated liver disease.

UVMCC: If people are diagnosed with fatty liver disease or alcohol-associated liver disease – can they reverse the process and reduce the risk?

Even in established fatty liver disease, loss of 10% body weight is sufficient to reverse organ damage.  Similar effects are seen with alcohol cessation in well-established alcohol-associated liver disease. Each of these measures should reduce the risk of liver cancer.

UVMCC: Are there liver cancer screening guidelines? If not, do you think there should be?  

Although every 6 month ultrasound has been shown in retrospective studies to reduce liver cancer-related death, liver cancer screening guidelines are not universally endorsed by all organizations.  The American Association for the Study of Liver Diseases (AASLD) supports ultrasound surveillance in high risk groups, the National Cancer Institute does not (the position is that there is insufficient evidence that the benefits outweigh the risks), and the American Cancer Society has taken an intermediate position. I agree with the AASLD, but I think that more work should be put into predictive blood-based biomarkers, which would reduce surveillance barriers.

For more commentary, read Attacking the public health crisis of hepatocellular carcinoma at its roots in Hepatology.

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