Liver Cancer is 'Largely Amenable to Primary Prevention'

Zosia Chustecka

October 27, 2011

October 27, 2011 — "Hepatocellular carcinoma, one of the most lethal human cancers, is largely amenable to primary prevention with existing knowledge and technology," according to American researchers. They report a study showing strong links between liver cancer and the modifiable risk factors of smoking, heavy alcohol consumption, and obesity, and between liver cancer and chronic infection with hepatitis B and C.

The findings, from a team led by Dimitrios Trichopoulos, MD, PhD, from the Department of Epidemiology at the Harvard School of Public Health, Boston, Massachusetts, were published online October 21 in the Journal of the National Cancer Institute.

The data come from the European Prospective Investigation Into Cancer and Nutrition (EPIC), a study that followed about 500,000 individuals from 1992 to 2000 in 10 countries in Europe. From this database, Dr. Trichopoulos and colleagues identified 115 patients with hepatocellular carcinoma, and matched them with 229 control subjects.

Investigators found that the highest risk factors for liver cancer were chronic hepatitis B infection (odds ratio [OR], 9.10) and chronic hepatitis C infection (OR 13.36), followed by obesity (OR, 2.13), former or current smoking (OR, 1.98 and 4.55, respectively), and heavy alcohol intake (OR, 1.77).

Smoking a Major Contributor

The researchers highlight smoking in particular. In this European cohort, smoking was associated with more hepatocellular carcinoma than chronic hepatitis infections.

Smoking contributed to almost half of all liver cancer cases (47.6%), whereas chronic hepatitis B and C infections contributed 13.2% and 20.9% respectively, they report. Obesity contributed to 16.1% of cancer cases, and heavy alcohol intake contributed to 10.2%.

When taken together, these documented risk factors accounted for 65.7% of all liver cancer in the European cohort.

An accompanying editorial also highlights the "remarkable and controversial" finding that smoking increases the risk for liver cancer.

"Somewhat surprisingly, smoking carried an attributable risk of almost 50%, a figure that challenges our current knowledge," write editorialists Morris Sherman, MD, and Joseph Llovet, MD, both from the Mount Sinai School of Medicine in New York City.

These data are compelling and we should take note.

Although they outline some limitations to the study — including the fact that smoking was reported in more than twice as many patients with liver cancer as in control subjects — they say: "These data are compelling and we should take note."

"We should be counseling our patients who have other risk factors for hepatocellular carcinoma to quit smoking," they write.

"There are many other health reasons to stop smoking," they acknowledge, adding: "Here is one more."

The authors have disclosed no relevant financial relationships.

J Natl Cancer Inst. Published online October 21, 2011. Abstract, Editorial

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