As many as three in five liver cancer cases could be prevented, according to a report from The Lancet Commission on liver cancer, which suggested that case numbers could be slashed by reducing alcohol consumption, levels of viral hepatitis and metabolic dysfunction-associated steatotic liver disease (MASLD).
Researchers have also flagged a notable increase in alcohol-related liver disease, particularly among women.
Previous analyses have predicted that the number of new liver cancer cases will nearly double from 870 000 in 2022 to 1.52m in 2050, primarily due to population growth and ageing populations, with the largest increases expected in Africa, reports Newsweek.
The number of deaths from liver cancer is also predicted to grow from 760 000 in 2022 to 1.37m in 2050.
It is already the sixth most common cancer and third leading cause of death from cancer globally.
The commission warns that the share of liver cancer cases caused by a severe form of MASLD (previously known as non-alcoholic fatty liver disease), called metabolic dysfunction-associated steatohepatitis (MASH) is expected to increase by a notable 35% come 2050.
The authors have called for increased awareness of the rising risk of MASLD, especially in the US, Europe and Asia, with a focus on high-risk groups like people with diabetes and obesity.
“Unfortunately through our literature review and discussion, we found the public, policy makers and sometimes clinicians aren’t aware of the growing problem of liver cancer,” clinical oncology Professor Stephen Chan from The Chinese University of Hong Kong told Newsweek.
Commission author Professor Hashem El-Serag of the Baylor College of Medicine in the US added: “Given that most cases of hepatocellular carcinoma (HCC, aka primary liver cancer) are not curable even with best effort and advancing treatments, prevention is the only realistic and cost-effective way of reducing both the incidence and mortality related to HCC.
“Prevention is uniquely possible in HCC because the main risk factors are known, detectable, and in many cases treatable and reversible.”
While around a third of the global population have MASLD, only 20%-30% of patients with it will develop the more severe form of the condition with liver inflammation and damage.
“We expect MASLD to be more problematic in the western world because of there being more metabolic causes like diabetes, fatty liver, people who are overweight… these also need behavioural modifications,” Chan said.
“MASLD is strongly associated with insulin resistance, which is outwardly associated with obesity and type 2 diabetes,” added El-Serag. “Diet both in terms of quantity and quality (high refined sugars, high saturated and trans fats, low fibres) is associated with increased risk of developing all three conditions.”
The commission highlighted several ways to reduce risk factors. These include increasing the coverage of the hepatitis B virus (HBV) vaccine and screening programmes, and boosting public health policies targeting obesity and alcohol consumption, like minimum alcohol unit pricing, warning labels and advertising restrictions.
The team also called for professional organisations and the pharmaceutical industry to unite to reduce differences between eastern and western regions of the world in the clinical management of liver cancer.
More obvious lifestyle changes, like “stopping drinking or drinking less”, are also needed, Chan said. However, he added: “There still aren’t many policies on helping high-risk individuals to make and sustain behavioural modifications.”
What about the knock-on effects of GLP-1 drugs for obesity? “These medications have already been shown to be effective treatments for MASLD, reducing liver fat and reducing liver fibrosis,” said El-Serag.
“Some observational studies have already indicated a possible reduction in cirrhosis and HCC associated with GLP-1s; while these findings need to be confirmed and expanded, they look promising. The issue becomes the scope: MASLD affects 25%-30% of the entire population.”
The researchers estimate that if countries can reduce the incidence of liver cancer cases by 2%-5% each year by 2050, it could prevent 9m to 17m new cases of liver cancer and save 8m to 15m lives.
In the US, about 42 240 new cases of liver cancer will be diagnosed this year, with about 30 090 people expected to die, according to the American Cancer Society. Liver cancer incidence rates have more than tripled since 1980, while the death rates have more than doubled during this time.
More than 40% of the global liver cancer cases occur in China, mostly due to relatively high rates of hepatitis B infections in the country.
“Liver cancer is a growing health issue around the world. It is one of the most challenging cancers to treat, with five-year survival rates ranging from approximately 5% to 30%. We risk seeing close to a doubling of cases and deaths from liver cancer over the next quarter of a century without urgent action to reverse this trend," said Commission Chair Professor Jian Zhou of Fudan University, China.
At least 60% of liver cancers are predicted to be preventable by addressing risk factors including HBV, hepatitis C, MASLD and alcohol. MASH is the fastest growing cause of liver cancer globally, followed by alcohol.
The proportion of liver cancer cases linked to HBV, however, is expected to decrease from 39% in 2022 to 37% in 2050, while hepatitis C-related cases are projected to drop from 29% to 26% over the same period.
"Liver cancer was once thought to occur mainly in patients with viral hepatitis or alcohol-related liver disease. However, today rising rates of obesity are an increasing risk factor for liver cancer, mainly due to the increase in cases of excess fat around the liver,” said El-Serag.
“One approach to identify patients at high risk of liver cancer would be to introduce screening for liver damage into routine healthcare practice for patients at high risk of MASLD, such as individuals who are obese, diabetic, and have cardiovascular disease.
“Healthcare professionals should also integrate lifestyle counselling into routine care to support patients to transition to a healthy diet and regular physical activity.
“Furthermore, policy makers must promote healthy food environments via policies like sugar taxes and clear labelling on products with high fat, salt, and/or sugar.”
Role of alcohol – and more women being affected
Not only have rates of liver cancer and liver disease increased over the past two decades, but other research shows that levels seem to be particularly high in women, whom experts note seem to be drinking more than than they did in the past.
Everyday Health reports that women are being diagnosed with liver disease far more frequently, according to lead study author Brian Lee, MD, a hepatologist and liver transplant specialist with Keck Medicine of the University of Southern California-Los Angeles.
With almost 133m American adults drinking alcohol, cases of liver disease have more than doubled over the past 20 years, but Lee says the reasons for this troubling shift are complex.
The current study defined heavy drinking as having 15 drinks or more a week for men and 10 drinks or more for women – a little more than two a day for men, and less than two a day for women.
“When I see patients, we talk about what heavy drinking is, and it’s much lower than what they think,” said Lee.
He added that heavy drinking is so pervasive “that it doesn’t seem heavy anymore, even though it’s causing liver failure and a host of other diseases”.
For the study, the researchers analysed data from the National Health and Nutrition Examination Survey (NHANES), a long-term study from 1999 to 2020 of more than 40 000 adults.
The scientists zeroed in on participants who met the definition of heavy drinkers, looking specifically at rates of liver disease and metabolic syndrome, which includes conditions like type 2 diabetes, high blood pressure, and obesity. (Previous studies have linked metabolic syndrome to a higher risk of developing liver disease among people who drink alcohol.)
Study participants who met the criteria for heavy drinking developed alcohol-related liver disease at more than double the rate they did two decades ago, the analysis found.
The risk of significant liver damage – a stage of liver disease when the liver forms scar tissue that impairs liver function – also more than doubled, going from nearly 2% between 1999 and 2004, to more than 4% between 2013 and 2020.
Metabolic syndrome diagnoses also increased during the study period, jumping from 26% to nearly 38% among heavy drinkers.
Four groups of people made up a larger share of heavy drinkers than they did 20 years ago:
• Women
• Adults 45 and older
• People living in poverty
• People with metabolic syndrome
The study didn’t determine why women are drinking more. “This is something that has been observed, and I’m not sure we have the exact answer,” Lee noted. Still, doctors have several theories.
“There’s been this normalisation of drinking. We talk about ‘mommy wine hour’ or ‘wine o’clock’,” he said. “This idea of drinking and drinking heavily is normal for women.”
Rising levels of stress and anxiety may also play a role. “Many people say they use alcohol to cope with stress and anxiety, and we know that women report having more stress and anxiety than men,” he added.
It’s important to point out that it’s not just women who are drinking heavily.
“The entire population is drinking more than before,” said Vinod Rustgi, MD, Director of hepatology at the Rutgers Robert Wood Johnson Medical School in New Jersey.
“This accelerated more during and subsequent to the pandemic, both due to social isolation and as a way to socialise,” added Rustgi, who wasn’t involved in the study.
Women more susceptible to liver disease
Women who drink the same quantity of alcohol as men will develop liver disease faster and at a higher frequency, and Lee suggested several reasons for this.
They typically have less water weight and a higher percentage of body fat than men. “At the same quantity of alcohol that they consume, you will see higher concentrations of alcohol in the blood,” he pointed out.
Women also have lower levels of an enzyme known as alcohol dehydrogenase, which helps the body metabolise alcohol. That can also lead to higher concentrations of alcohol in the blood. Combined, those factors tax the liver, which has to process alcohol, ultimately raising the risk of developing liver disease.
“The liver has tremendous regenerative capacity,” the doctors said, but there is a point of no return. “We see women in their late 20s, early 30s who have been drinking more than usual and who develop permanent damage.”
Lancet study details
The Lancet Commission on addressing the global hepatocellular carcinoma burden: Comprehensive strategies from prevention to treatment.
Stephen Lam Chan, Hui-Chuan Sun, Yang Xu et al.
Published in The Lancet on 28 July 2025
Liver cancer is the sixth most common cancer and the third leading cause of cancer-related mortality globally. The number of new liver cancers will nearly double, from 0·87 million in 2022 to 1·52 million in 2050, if there is no change in the current trend. Hepatocellular carcinoma, the most prevalent histological subtype of liver cancer, accounts for approximately 80% of all primary liver cancers. In response to this issue, a Commission comprising a broad spectrum of experts in clinical medicine and public health was established with the primary objective of addressing the rising disease burden of hepatocellular carcinoma. We undertook a systematic process of idea generation, literature review, evidence scoping, novel data synthesis, and modelling, as well as case study analysis to underscore the urgent need for global action against hepatocellular carcinoma. First, we present the new finding that an annual reduction of at least 2% in the age-standardised incidence rate (ASIR) is required to stop the rising burden of new cases of liver cancer. Accordingly, the Commission has set a goal of achieving at least a 2% reduction in the ASIR. For some regions where reductions in ASIR have already been observed, we propose a more ambitious goal of a 5% reduction. If an annual 2–5% reduction in ASIR is achieved over the next 25 years, we estimate that 8·8–17·3 million new cases of liver cancer could be prevented, and 7·7–15·1 million lives could be saved.
The Lancet Commissions (Restricted access)
Newsweek article – 60% of Liver Cancer Are Preventable, Report Reveals (Open access)
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