Liver cancer

This policy presents information about liver cancer including evidence-based strategies to prevent primary liver cancer (cancer that originates in the liver). It will be updated as significant new literature is published or if there are important changes in the policy environment.

The chapter was updated in July 2019. It has been reviewed internally by the Screening and Immunisation Committee of Cancer Council Australia and externally reviewed by Professor Benjamin Cowie, Infectious Disease Epidemiologist and Physician, WHO Regional Reference Laboratory for Hepatitis B, Victorian Infectious Diseases Reference Laboratory, and Victorian Infectious Diseases Service, Royal Melbourne Hospital Department of Medicine, University of Melbourne; and Associate Professor Mark Danta, Senior Lecturer in Medicine, Gastroenterologist and Hepatologist, Faculty of Medicine UNSW and St Vincent's Clinical School. It has been approved by Cancer Council's principal Public Health Committee.

Contact: Amanda McAtamney

Key policy priorities in summary

• Develop and implement national liver cancer control strategy
  • Increase awareness of risk factors for liver cancer
  • Optimise vaccine coverage in high-risk populations such as Aboriginal and Torres Strait Islander people and migrants born in countries with high hepatitis B prevalence
  • Improve access to treatment and care for individuals with hepatitis B and C
  • Implement a liver cancer surveillance program

Liver cancer is the sixth most common cancer globally, and the fourth most common cause of cancer death ^[1]. While liver cancer incidence in Australia is low compared to other regions, liver cancer mortality rates are growing faster than any other cancer in Australia^[2]. From 1982 to 2019 the age-standardised incidence rate for liver cancer increased 378%, and the age-standardised mortality rate for liver cancer increased 20.4%^[2].

Chronic Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections combined are the leading causes of liver cancer globally and in Australia. The Global Burden of Disease Study 2015 estimated that 48% of liver cancer cases were attributable to HBV and HCV ^[3].

A significant proportion of liver cancers are preventable through primary prevention strategies to reduce or eliminate transmission of HBV and HCV, and through early detection and appropriate management and treatment of infected individuals. Smoking, alcohol, and aflatoxins are also causes of liver cancer. Other risk factors of increasing importance are obesity, type 2 diabetes, non-alcoholic fatty liver disease (NAFLD) and haemochromatosis.

Vaccination is an effective primary preventive approach against HBV. Strategies to reduce obesity (and hence type 2 diabetes and NAFLD) ^[4], reduce smoking rates and curb alcohol intake will also reduce future liver cancer burden. These strategies are described in the Overweight and obesity, physical inactivity and nutrition, tobacco, and alcohol chapters, respectively.

Secondary prevention of hepatitis-related liver cancer aims to reduce the proportion of infected people progressing to liver cirrhosis and cancer. Successful strategies include testing of high-risk groups; antiviral therapies; and ongoing surveillance and management of infected individuals.

Improving outcomes for liver cancer relies on early detection and appropriate treatment. A major barrier to achieving this is a lack of understanding and awareness of risk factors among both the public and health practitioners.

This chapter of Cancer Council Australia’s National Cancer Prevention Policy discusses liver cancer's impact, covers the current policy context in Australia and summarises Cancer Council Australia's recommended, evidence-based policy priorities to reduce the burden of liver cancer in Australia. Finally, it presents the risk factors and evidence on primary and secondary prevention strategies.