Liver Cancer: A Preventable Tragedy
A quiet storm is brewing in oncology clinics around the world, and its name is liver cancer.
According to a sweeping new analysis published in The Lancet and recently reported by Nina Agrawal in The New York Times, liver cancer remains one of the most lethal and fastest-growing forms of cancer globally—yet, alarmingly, three out of five cases could be prevented. The findings come from an international commission of experts who warn that unless meaningful action is taken, we are on track for 1.5 million new cases of liver cancer annually by 2050, nearly double the current burden.
What makes this especially tragic, as liver specialists have long observed, is that liver cancer doesn’t have to be this common. Most cases emerge from preventable causes: hepatitis B, hepatitis C, alcohol-associated liver disease, and the increasingly prevalent metabolic-associated steatotic liver disease (MASLD, formerly NAFLD).
A Highway to Cancer
Liver cancer typically arises in the setting of cirrhosis—a final common pathway for multiple liver insults. The study’s authors describe how viruses (HBV, HCV), alcohol, and metabolic stress from obesity and diabetes all lead to chronic inflammation and fat accumulation in the liver, eventually causing fibrosis, cirrhosis, and ultimately malignancy.
Dr. Brian Lee, a hepatologist at USC, referred to this process as a “highway” to liver cancer—with multiple on-ramps. The metaphor captures the grim reality: whether you arrive via hepatitis, heavy drinking, or silent metabolic syndrome, the destination is often the same.
The Underrecognized Threat of Metabolic Liver Disease
One of the report’s most sobering warnings is the growing threat of MASLD and its progressive form, MASH (metabolic-associated steatohepatitis). Globally, MASLD now affects about 40% of adults—many of whom are completely unaware of the damage occurring in their livers.
Dr. Ahmed Kaseb of MD Anderson Cancer Center emphasized that these metabolic conditions are stealthy. Most people with MASH do not meet current criteria for cancer screening, yet many harbor silent fibrosis or even cirrhosis. By the time they’re diagnosed, curative options are few.
The commission recommends wider use of non-invasive tools like the Fib-4 index—a simple score based on routine blood tests—to screen high-risk individuals in primary care, especially those with obesity or Type 2 diabetes.
Alcohol and Obesity: A Deadly Duo
The data also show a disturbing synergy between alcohol and metabolic disease. In a recent U.S. study, Dr. Lee found that while overall alcohol consumption has remained stable, the risk of alcohol-related liver damage has surged. Why? More of today’s heavy drinkers are women and individuals with obesity or metabolic syndrome—both groups more vulnerable to alcohol’s toxic effects.
The convergence of these risk factors has created a perfect storm. As Dr. Mary Rinella of the University of Chicago Medicine bluntly put it: “Alcohol use is increasing. Obesity and diabetes are increasing. I expect that we’re going to continue to see a high burden of liver disease.”
What Can Be Done
Here’s the hopeful part: liver cancer is not inevitable.
The Lancet Commission outlines a roadmap that includes:
Expanding hepatitis B vaccination and hepatitis C treatment globally.
Promoting early screening using tools like Fib-4 and liver elastography.
Encouraging public health campaigns to address alcohol misuse and promote healthier lifestyles.
Investing in therapies that reverse liver fibrosis—such as weight loss medications and GLP-1 receptor agonists.
As CEO and co-founder of BDUK Therapeutics Ltd., a company developing a locoregional liver cancer therapy using porous microspheres, I see firsthand the urgent need for both prevention and innovation. Treatments like ours aim to offer hope to patients already facing advanced disease. But we must pair innovation with prevention to change the global trajectory of this cancer.
Israel’s Opportunity and Responsibility
In Israel, as elsewhere, the burden of MASLD is rising in both Jewish and Arab populations. Our health system—grounded in universal access—has a unique opportunity to implement primary care-based liver screening. Public education campaigns, diet and exercise interventions, and early identification of liver damage can save lives before cancer even develops.
We owe it to future generations to address the modifiable causes of liver cancer now. The science is clear. The tools exist. What’s needed is the will to act—before more lives are needlessly lost.
References:
Agrawal, N. (2025, July 28). 3 Out of 5 Liver Cancer Cases Are Preventable, Study Finds. The New York Times.
Chan, S. L., Zhou, J., El-Serag, H. B., Paradis, V., et al. (2025, July 28). The Lancet Commission on addressing the global hepatocellular carcinoma burden: comprehensive strategies from prevention to treatment. The Lancet. DOI: 10.1016/S0140-6736(25)01042-6
