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Despite the fact that most cases of liver cancer could be prevented, it remains one of the top three causes of cancer death worldwide. A study published in the Journal of Hepatology in October last year warned that by 2040, the annual number of new cases and deaths is predicted to increase by more than 55 per cent. In 2020, an estimated 905,700 people were diagnosed with liver cancer and 830, 200 people died from the disease worldwide. If this rate of incidence and mortality continues, the researchers predicted that 1.4 million people could be diagnosed with liver cancer and as many as 1.3 million people could die from the disease in 2040. Every year, 19th April, is dedicated as World liver day to spread awareness about liver related diseases. On this occasion, health experts raise concern about India's increasing liver cancer burden.
Liver cancer or hepatocellular carcinoma (HCC) has become a serious public health concern in India, with unpublished data from multiple tertiary care institutes in the country reporting that the incidence of HCC is rising. In India, the highest incidence of liver cancer, are reported in the Northeast states, particularly Sikkim and Arunachal Pradesh.
Why the prevalence of Liver Cancer is high in Northeast Indian states ?
"Northeast is India's worst cancer afflicted region. While the incidence of oral, breast and cervical cancer has always been on rise, Liver cancer too remains one of the leading causes of death from cancer," says Prof (Dr.) Major (Retd.) Shibashish Bhattacharyya, Sr. Consultant - Medical Onoclogy & Hemato Oncology with BMT American Oncology Institute (AOI), Imphal.
According to him, the primary reason for the prevalence of liver cancer in Northeast India is the increase in Hepatitis B & C infected population in the region.
Prof. Shibashish expounds, "Both Hepatitis B & C viruses attack liver cells and are the primary causes of liver cancer. While the prevalence of Hepatitis B in states like Assam is reported to be approximately 2 per cent, it is 7-8 per cent in Arunachal Pradesh, Sikkim and pockets of Tripura. Hepatitis is an inflammation of the liver. Healthcare professionals, people with multiple sex partners, intravenous drug users, patients who receive blood or blood components are at a higher risk of getting infected. To prevent liver cancer, it is important to avoid all the risk factors of Hepatitis A, B, C and E and get vaccinated for Hepatitis B. Also, alcohol and tobacco consumption is highest in Arunachal Pradesh and other northeastern states which causes liver cancer."
On World Liver Day, health experts also throw light on the challenges they face in the treatment of liver cancer. According to them, most patients suffering from liver cancer (more than 80 per cent) usually report for treatment in intermediate and advanced stages, making treatment difficult and many lives are lost in the process. If the cancer is detected in the early stage, there are ways to effectively manage it.
When liver cancer is diagnosed at an advanced stage, curative treatments such as surgical resection, ablation, or liver transplantation may not be an option, according to experts.
Studies on liver cancer have identified delay in routine testing or screening as the reason why HCC is often diagnosed at an advanced stage in developing countries like India. Researchers have stressed the need for developing effective treatment regimens for such stages. Immunotherapy is considered a promising treatment option that may help increase overall response and survival rate.
Vijith Vittal Shetty and Adithi Kellarai from K.S Hegde Medical Academy, Mangalore, conducted an extensive search for studies published between January 2000 and June 2022 on the epidemiology of hepatocellular carcinoma (HCC) in India through PubMed and MEDLINE. The results were published in JCO Global Oncology, an American Society Of Clinical Oncology Journal.
The results showed that the most common risk factors for the development of HCC in India are nonalcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infection, liver cirrhosis, and alcohol intake.
An International Agency for Research on Cancer (IARC) study on the role of alcohol consumption suggested that 17 per cent of all liver cancer cases diagnosed in 2020 could have been avoided by reducing alcohol consumption. Tobacco smoking can also cause liver cancer. While infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) ae the major modifiable risk factors for primary liver cancer, the increasing prevalence of other risk factors, such as type 2 diabetes and obesity, is likely to drive liver cancer incidence, the IARC scientists noted.
The World Health Organization (WHO) acknowledges liver diseases as the 10th most common cause of deaths in India, with a staggering 10 lakh Indians diagnosed with liver cirrhosis every year. Liver cirrhosis is also one of the leading causes of deaths in the world.
In India, the available data suggest that age-adjusted incidence rates of liver cancer range from 1 to 7.5 per 100,000 population, 0.7 to 7.5 among men, and 0.2 to 2.2 in women.
Commenting on the World Liver Day, Dr. Abhai Singh, Senior Consultant, Gastroenterologist, Primus Super Speciality Hospital, New Delhi, says that the day reminds us of the growing burden of liver disease worldwide.
According to Dr. Singh, liver illness has spread like an epidemic in India, affecting one out of every five persons as reported in January 2023. India records 268,580 liver-related deaths every year, accounting for more than 18 per cent of the global count (2 million liver-related deaths).
He points out that the rate of liver cancer of occurrence has tripled since the 1980s, and by 2030, deaths from liver cancer is projected to reach 1.1 million.
Dr. Singh adds, "However, we have the tools to prevent and manage the liver disease, including lifestyle modifications, vaccination against hepatitis B, and early detection and treatment of hepatitis C. Liver transplantation also offers hope for those with end-stage liver disease."
Emphasizing on the seriousness of the situation, the Gastroenterologist says that around 30-40 per cent of his outpatient department's patients have liver issues and each month, he attends to approximately 30-35 individuals with liver ailments, falling between the ages of 30-60. Consuming high amounts of junk food, high-fat diets, and sugary drinks were the leading causes of their illnesses.
On this World Liver Day, let us recommit ourselves to raising awareness about liver health and working towards a world where liver disease is no longer a leading cause of death, Dr. Singh concludes.
Prevention is key in reducing the incidence of and mortality from liver cancer. Hence, on World Liver Day experts stress the need to focus on liver cancer prevention measures, such as immunization, testing, and treatment for HBV infection and population-wide testing and treatment for HCV infection. Additionally, measures to reduce alcohol consumption and reduce the prevalence of diabetes and obesity can all help bringing down the liver cancer burden, they add.
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