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Opportunities to improve surveillance of hepatocellular carcinoma in Australia

Year: 2025

Type: article

Abstract: Opportunities to improve surveillance of hepatocellular carcinoma in Australia T he incidence and impact of primary liver cancer in Australia is growing.Over the past two decades, there have been major gains in the fight against cancer in Australia.Despite our ageing population, overall cancer mortality has decreased.1 Yet, primary liver cancer remains an outlier to this trend: in 2019, the estimated incidence of primary liver cancer was more than four times higher (10.1 cases per 100 000) than in 1982 (2.2 cases per 100 000), a faster increase than any other type of cancer in Australia. 1 Primary liver cancer is also a low survival cancer, with a five-year survival of only 22%. 1 Hepatocellular carcinoma (HCC) accounts for over 85% of primary liver cancer, 2,3 and usually develops in the setting of chronic liver disease, with up to 90% of cases occurring in people with liver cirrhosis.3 Previously, viral hepatitis and alcohol-related liver disease were the most common aetiologies of HCC. 4 However, metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly emerging as a major cause of HCC. 5 In contrast to many other cancers, the at-risk population for HCC is well defined.6 Moreover, when detected at an early stage, patients can be offered curative treatments.3 Surveillance for HCC in individuals at risk with six-monthly liver ultrasound scans, with or without the α-fetoprotein (AFP) blood test, improves HCC survival, is recommended in guidelines and is cost-effective in the Australian context.7,8 New strategies are urgently needed to reduce deaths from liver cancer in Australia Due to a low uptake of surveillance, most HCC cases continue to be detected at an advanced stage when only palliative treatments can be offered.Data from Melbourne show minimal change in the proportion of new HCC cases diagnosed through surveillance over the past decade, from 40% in 2013 to 39% in 2022.9,10 This is primarily due to lack of awareness among health workers and the community of who is at risk of chronic liver disease and HCC, the asymptomatic nature of chronic liver disease and HCC in the early stages, lack of awareness of the survival benefits of HCC surveillance for individuals at risk, and lack of access to HCC surveillance.11 The impact of late diagnosis of HCC on mortality is even more striking among people who face barriers to care, including First Nations Australians and those who experience social and health disadvantages.12 Yet, in some east Asian countries, between 2000 and 2020, both the incidence and mortality of primary liver cancer have fallen, reflecting successful preventive health initiatives that address viral hepatitis, such as hepatitis B vaccination and treatment, and hepatitis C cure.2,13 However, improvements in HCC mortality may also be driven by early diagnosis and increased use of curative treatment.14 Taking

Source: The Medical Journal of Australia

DOI: 10.5694/mja2.52691