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Liver Cancer: Causes and Risk Reduction Strategies

Tracey Simon, MD, MPH
Instructor of Medicine, Harvard Medical School
Assistant Professor, Gastroenterology
Massachusetts General Hospital
Boston, MA

How Lifestyle Choices are Increasing Incidence of Liver Cancer

Liver Cancer (hepatocellular carcinoma) is a rare cancer overall, but it has been increasing over the last 30 years in the United States. It is now one of the leading causes of cancer and also of cancer related mortality, both in the US and worldwide. And that is largely due to the growing prevalence of lifestyle related liver diseases.

Both alcohol and non-alcoholic related fatty liver disease are two of the driving forces behind this change in liver cancer. As we have developed hepatitis B and C treatments that are very effective, the sort of the proportions of liver cancer that are due to these various causes have shifted over the last five to 10 years.

What we are seeing is a growing proportion of cases that are due to nonalcoholic fatty liver disease and alcohol-related liver disease. And that has been an increasing area of concern just because what we lack are clear preventative strategies for those conditions in particular, as opposed to direct acting antiviral therapy for hepatitis C, for example.

The Potential Impact of Aspirin in Patients with Liver Cancer

We have done quite a few studies and have shown that aspirin in numerous populations around the world has a strong inverse association with the incidence of liver cancer. And we are in the planning stages of future clinical trials, but to date, there has yet to be a randomized clinical trial that has directly tested the effectiveness of aspirin for the prevention of liver cancer. And that has been a bit of a challenge that is related to the rare nature of this cancer. Such a trial would require a large number of people, called for very long period of time. But in association studies, we have seen very strong, protective associations between aspirin use and the reduced risk of developing liver cancer in various populations. The best studied groups have been populations of patients with chronic viral hepatitis, but it also has been demonstrated in patients without chronic viral hepatitis as well, which is very promising.

We know that the benefits of aspirin for secondary risk reduction in cardiovascular disease are very well established. And I think in the last few years, there has been some controversy that has emerged about the use of aspirin for primary prevention of cardiovascular disease, particularly in, for example, older adults over the age of 75. There are certain higher risk groups for whom aspirin use for primary cardiovascular prevention is not indicated or controversial and should be discussed with their treating physician.

Aspirin also has established benefit for the prevention of colorectal cancer development. That has been established very nicely in large population based observational studies and in randomized controlled trials as well.

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