Alcohol use, alone or in combination with other causes, already accounts for up to 55% of liver cancer cases, the second-highest remaining year of life.

Tomorrow, Wednesday, February 14, at the 49th Congress of the Spanish Society for the Study of the Liver (AEEH), the results of the III Registry of Hepatocellular Carcinoma (HCC), which collected demographic and clinical data from 767 patients, will be presented. diagnosed with a tumor of primary liver cancer isolated from 52 centers during the period from October 1, 2022 to January 31, 2023. These data allow us to know the evolution of the etiology of liver cancer over the past fifteen years in our country and indisputably show that alcohol consumption is its first cause, regardless of whether it is considered in isolation (29.9% of cases) or associated with other causes (54.9% of cases).

These data highlight the failure of alcohol control policies to reverse alcohol consumption as a leading cause of hepatocellular carcinoma, which remains stable. This means that almost six out of every ten cases of liver cancer in Spain are caused by alcohol, which also leads to two paradoxical and at the same time merging circumstances: while liver cancer is already the type of cancer that takes the most years of life from population. Perceptions of the risks associated with drinking alcohol in our country remain unchanged, and in fact young people begin drinking at increasingly younger ages and in high-risk patterns (drinking large amounts of alcohol over several hours).

An alarming trend

At the same time, the III HCC AEEG Register notes an increase in HCC in people with liver diseases in milder stages, without the presence of liver cirrhosis, which almost doubles, from 4.2 to 7.9% of cases, and clearly shows an increase in cancer cases liver caused by metabolic hepatic steatosis, EHmet, which is the name for the pathology of fatty liver. Compared with data from 2008 and 2014, the Registry results show an increase of almost ten points (1.9% vs. 5.9% and 11.8%) in the percentage of hepatocellular carcinomas due to EGmet, which is confirmed as a third cause of liver damage. cancer, and the one with the fastest growth.

This trend is of great concern to experts, who in fact believe that steatohepatitis will become the leading cause of HCC within a decade, given the progress in the prevalence of fatty liver. In fact, it is estimated that this pathology already affects more than ten million Spaniards, of whom almost two million have liver inflammation (steatohepatitis) and 400,000 already have cirrhosis, with the aggravating factor that the majority have not yet been diagnosed.

This is an unstoppable advance that is alarming for many reasons, especially the impact it could have on liver cancer. “The presence of liver cancer in patients with fatty liver disease in Spain has tripled in the last decade, and these data tell everything about the scale of the problem we will have to face,” said AEEH President Manuel Romero.

Improved Early Detection

The good news is the continued decline in the proportion of hepatitis C (HCV) in the total number of HCC cases, which has decreased over fourteen years from 43% to 17.5%. Despite this progression, hepatitis C remains the second risk factor for liver cancer, which is why experts are calling for a definitive effort to eliminate it, which largely involves increasing screening among vulnerable populations and facilitating their access to treatment.

But data from the AEEH Registry III not only shows that the epidemiology of liver cancer is changing, but also that efforts to increase detection through screening programs are insufficient. In this sense, it is noteworthy that the proportion of patients with cirrhosis diagnosed with breast cancer in screening programs has not changed and therefore has not been able to increase dramatically. Currently, 43% of cases are detected outside of these programs. The problem is that when HCC is diagnosed outside of screening, the disease is usually at a more advanced stage at which curative treatment is unlikely to be offered, resulting in a significantly worse prognosis.

These results indicate the need to improve liver cancer screening programs as well as strengthen the prevention of alcohol-associated liver disease and fatty liver disease. Every year 6,600 new cases of liver cancer are diagnosed in Spain, half of them in very advanced stages, and it is the leading cause of death in patients with cirrhosis caused by alcohol consumption or viral hepatitis.