Liver Cancer Cases are Expected to Double by 2050 (10:37)
Broadcast Retirement Network’s Jeffrey Snyder discusses the rise in liver cancer diagnosis with Hashem El-Serag, M.D., Baylor College of Medicine.
Jeffrey H. Snyder, Broadcast Retirement Network
This morning, liver cancer cases are projected to double by 2050. Joining me now to discuss this is Dr. Hashem El-Sarag of Baylor College of Medicine. Dr. El-Sarag, great to see you. Thanks for joining us on the program this morning. Thanks for having me. Looking at this data, it concerns me, so I imagine it does concern you.
Liver cancer cases are going to be on the rise.
Hashem El-Serag , MD., Baylor College of Medicine
Yes, indeed. I think the report shows two aspects, big picture. One is a concerning one, that the number of liver cancer cases are expected to almost double by the year 2050.
That’s worldwide. If things continue on the current track. The flip side of this, that almost two-thirds of cases of liver cancer are caused by something that is potentially preventable.
Either preventable by vaccination or screening or treating, but we’ll talk about that in detail.
Jeffrey H. Snyder, Broadcast Retirement Network
Yeah, it’s an alarming increase. If you could share, doctor, what will cause this increase in liver cancer cases?
Hashem El-Serag , MD., Baylor College of Medicine
Yeah, I think an easy way to understand this is to think of what causes liver cancer. There are a few major risk factors. One is hepatitis B, which still is the major risk factor worldwide, particularly in the Far East, China, for example.
The second is hepatitis C, which has pockets of high prevalence all over the world. The third one is alcoholic liver disease. The fourth one, which is really a new entity and a major driver of our report, is to highlight and increase the awareness of this entity that is called metabolic dysfunction associated steatotic liver disease.
I know it’s a mouthful.
Jeffrey H. Snyder, Broadcast Retirement Network
That is a mouthful. It’s known as fatty liver. Let’s talk about fatty liver because you said this is kind of a newer…
I don’t want to put words in your mouth, but I’m kind of paraphrasing. This is kind of a newer cause, causation, if you will. It sounds like fatty liver to me sounds like diet-related, what we’re consuming in our diets.
Yes.
Hashem El-Serag , MD., Baylor College of Medicine
First, I want to tie it to your previous question. We think that the increase of liver cancer related to fatty liver is a large part of the driver of future cases of liver cancer, that and alcoholic liver disease. Both hepatitis C and B are actually on their way declining.
But going back to fatty liver disease, first, it is so common, and I think the word epidemic sometimes is used outrageously or superlatively. But in this case, it’s true. 25% to 30% of all adults are estimated to have fatty liver today.
It is estimated that 20% of those might progress to a condition that is not just fatty liver, but fatty liver inflammation and scarring. It’s called MASH. Of those, a proportion will develop the dreaded condition, which is called cirrhosis of the liver.
Cirrhosis of the liver is really the condition that predisposed to the development of liver cancer. So going back to fatty liver, what’s causing this epidemic? I believe it’s a combination.
As you mentioned, diet, proliferation of multiple unhealthy dietary practices, purified sugar, lower fibers, high fats, in combination, has led to an obesity epidemic. So the diet with the increased body weight together produce a syndrome called insulin resistance, where the body’s insulin is not capable of performing its optimal functions, one of which is cycling off the fat of the liver, and therefore more fat accumulates, and you get fatty liver. And with time, meaning two to four decades, that fat causes inflammation, which then causes scarring.
Lots of scarring is cirrhosis, cirrhosis precursor to liver cancer.
Jeffrey H. Snyder, Broadcast Retirement Network
And how would I know if I have a fatty liver? I’m assuming you can’t just look at the body and say, oh, your liver’s fat. Are there blood tests when you go to visit your primary care physician that would alert you to whether or not you have this condition?
Hashem El-Serag , MD., Baylor College of Medicine
So this is one of the major pushes of our report, is to better implement screening for fatty liver disease and risk stratification. So it’s two steps. Do you have fatty liver disease?
And are you part of the 20% or 30% that are more likely to have bad complications? And there are many recommendations and guidelines and recommended testing, but most of whom revolve around something basic, which is blood tests. There’s things called liver enzymes.
In combination with the presence of diabetes and or obesity, and there are now calculators that could be incorporated in the electronic health records that screens people at the first cut. Are they at a high risk for having fatty liver disease or not? And if they flag as yes, based on blood tests, obesity or diabetes, and next test, which is fairly diagnostic and it’s non-invasive and it’s cheap, it’s an ultrasound-based technology to measure the degree of fat and the degree of scarring in the liver.
A test called Fibroscan, for example, is commonly used. So that combination is what we recommend for screening and risk stratification for fatty liver disease. But it really starts by awareness, because awareness is what drives the systematic screening.
And in a world where our primary care doctors have 20 or 30 things to do, this can easily straight through. Particularly that it is an asymptomatic condition.
Jeffrey H. Snyder, Broadcast Retirement Network
No one complains of fatty liver. Sorry to interrupt you. I was going to just say, it sounds like you as the patient, me as the patient, I need to be aware of this.
I bring it to my, as a idea or concept to my primary care physician, then he or she would say, hey, Jeff, you’re not at risk or you are at risk. Let’s do some blood work. Yes.
Hashem El-Serag , MD., Baylor College of Medicine
And I think you as a customer or a client, it’s relatively easy. I mean, you know, whether you have diabetes, high cholesterol, high blood pressure or obese. And if you have particularly more than one of these risk factors, I think you should be proactive.
Do you think I have fatty liver? And it’s easy to find out.
Jeffrey H. Snyder, Broadcast Retirement Network
Let’s talk about if you are diagnosed, is this reversible? So let’s just say you have fatty liver. You’ve gone through the testing.
You’ve talked to the doctor. He or she issues the testing. You get the test.
And it says Jeff Snyder is one of those 25% that might have a fatty liver. Is this all reversible? What do I need to do to kind of change course so that I don’t develop cirrhosis?
I don’t develop the scarring that you were talking about?
Hashem El-Serag , MD., Baylor College of Medicine
Yeah, this is the good news, actually, about all four major risk factors, that if you catch them at a certain stage, especially before the cirrhosis develops, they can be quite reversible. So going back to fatty liver, it is estimated that losing anywhere between 5% to 10% of body weight and keeping it off in someone who has simple fatty liver, perhaps with a little bit of inflammation, can reverse the whole thing. Even in those who have advanced scarring and inflammation, weight loss helps in reversing some of that.
And of late, there are a few medications now on the market that have shown promise and effectiveness in reversing fibrosis. Most notably is this new category of medications that you hear about all the time, the GLP-1 agonists like Wagovis and Monjaro and the likes. But there are others too.
Jeffrey H. Snyder, Broadcast Retirement Network
Yeah, so just to kind of sum up at the end here, it sounds like a lot of this is in each individual’s control. We control what we’re consuming, we control our lifestyle, we can control how we interact with the doctor, and then we can control what, if anything, we need to do as a result of all these tests. It is reversible.
Hashem El-Serag , MD., Baylor College of Medicine
We are partially in control, but no one lives alone. So people need to seek help. It is easier, faster, and more sustainable to lose weight through the help of a dietary plan or a dietician.
It is easier, faster, and more sustainable to seek professional help on physical activity. Taking medications and sticking to them will produce results. So, yes, it is under our control, but there are many available resources to make people do it better and faster.
Jeffrey H. Snyder, Broadcast Retirement Network
Well, doctor, thank you so much for all the research and the work that you and the team are doing. And we look forward to talking again with you and having those numbers actually go down over a long period of time. Great to see you.
Thanks for joining us. And we look forward to having you back on the program again very soon.
Hashem El-Serag , MD., Baylor College of Medicine
Thank you, Jeff, for covering this story.
Jeffrey H. Snyder, Broadcast Retirement Network
It’s important work. Thank you. Well, that wraps up this morning’s episode.
Until tomorrow, I’m Jeff Snyder. Stay safe, keep on saving, and don’t forget, roll with the changes.