Q&A: Patient initiative will drive fight against rising liver cancer rates
Liver cancer incidence and related mortality rates have been increasing significantly in the United States over the last 15 years, following increasing trends in obesity, nonalcoholic fatty liver disease and alcohol use.
According to a recent report from the CDC, liver cancer mortality increased from the ninth leading cause of cancer death in 2000 to the sixth leading cause in 2016, with rates increasing significantly for both men and women and the highest rates seen in adults aged 45 years or older.
Additionally, data presented recently at the American College of Gastroenterology 2018 meeting highlighted changing indications for liver transplantation, with obesity and NAFLD becoming the driving risk factors for end-stage liver disease.
Tom Nealon, president and CEO of the American Liver Foundation, spoke with Healio Gastroenterology and Liver Disease about these alarming trends and how important is it for patients to take initiative to speak with their doctors about potential risk factors and liver function examinations. – by Talitha Bennett
Healio: With the exceptional rise of liver cancer rates in the U.S., what is necessary for a plan of action?
Nealon: Each patient has to initiate and work hand-in-hand with their physician. The biggest challenge that we have is that so many liver diseases are symptom-free until very late stage. If you’re waiting for symptoms, by the time they appear, your options have been severely reduced. That’s why we really promote patients being aware of the risk factors. We’ve had a campaign for the last couple years that’s built around the question: “Are you at risk?” It really calls upon patients to be conscious and aware of the risk factors and the issues that can potentially give rise to liver cancer and do all they can do to make sure that they consult with their physician if they have any of those risk factors or if there’s any family history to be concerned about.
Healio: What are the common drivers of end stage liver disease and liver cancer?
Nealon: This year, it’s changing slightly. There’s always been chronic hepatitis, people who are morbidly obese, people with diabetes, excessive alcohol abuse, metabolic syndrome, and even ethnicity — but what’s really been highlighted now is nonalcoholic fatty liver disease, which has basically become a national epidemic. It’s now estimated that up to 25% of the U.S. population has nonalcoholic fatty liver disease. Unfortunately, the progression of that will lead to liver cancer if not caught in time — not in every case, but it is a strong driver of that. So much so that it is anticipated that it will radically increase the rates of liver cancer and, in the next 5 or so years, will be the No. 1 reason for liver transplant in the U.S.
Healio: What is the state of liver cancer screening and can it be improved?
Nealon: Part of the problem is that there isn’t really any standard screening during annual physical exams. The driver has to be the individual patient going to their doctor and saying that they have concerns because of any of the risk factors I mentioned. This is the part where [patients] have to step up. It’s one of our ongoing problems with people who have liver disease. Generally, people don’t like to speak about the fact that they have or might have liver disease or might even have any of these factors associated with it. The challenge remains: getting people to realize speaking up could save their life. The faster they get to their physician and get a proper screening or diagnosis, the better their chances of survival, because, unfortunately, most recent data has shown that 5-year survival rates are in the “teen” percentages because it is diagnosed so late.
Healio: What can be done to improve patient awareness?
Nealon: We’re working on a couple initiatives around that. There was a recent survey, not by us, but it showed that about 25% of people when asked about their liver had said, “You don’t need a liver.” This is not an appendix here, where you can debate the utility. People are remarkably unaware about their liver — where it is and its function — when it is in fact the largest organ in the body that works 24/7 to purify and process everything you eat, drink, ingest. You would think, “Wow, I need to take care of that.” It is remarkably resilient, because it can be mistreated and come back, but only if there’s a proper diagnosis. Being prompt and aggressive about learning about your liver health can really extend your life.
Healio: G astroenterology and hepatology specialists can provide much of this information , but may not see a potential patient until it is too late . W hat can primary doctors do?
Nealon: Primary care physicians can sometimes be prone to understate the risks that might be involved with liver disease. As an example from HCV, I knew a patient who was in the baby boomer generation and asked their doctor if they should be tested. When the doctor asked if they were an intravenous drug user, and the patient said no, the doctor said they probably didn’t need to be tested. It’s a general misunderstanding of the gravity of the host issues that are out there. Patients with risk factors should make sure that their primary care physician refers them to a specialist. It’s worth an examination to get a reassurance or confirmation in a timeline fashion.
They owe it to themselves, to their family and to potential care givers to not wait until it reaches a point where there are very limited options. Relying on liver transplantation to save you is not a wonderful idea, because even though last year there were more transplants performed in the U.S. than in any year before, the gap between the number of transplants and the number of people waiting grows every day.
Disclosure: Tom Nealon is the president and CEO of the American Liver Foundation.