At least 60% of liver cancers could be preventable, according to an analysis published Monday in The Lancet.
Liver cancer is the sixth most common cancer in the world, with around 870,000 cases in 2022. That’s projected to increase to 1.52 million cases in 2050, the new report found, if no changes are made.
The leading cause of liver cancer is viral infections, including the hepatitis B and C viruses. Hepatitis B infections — which are preventable with a vaccine — accounted for 39% of liver cancers in 2022. That’s expected to fall slightly, to 36.9%, by 2025. Hepatitis C accounted for 29.1% of liver cancers in 2022 and is also projected to fall, to 25.9%, by 2050.
The proportions of alcohol- and obesity-related liver cancers, however, are projected to rise in the next 25 years. Alcohol accounted for 18.8% of liver cancers in 2022, and that is expected to increase to 21.1% in 2050. The share of liver cancers caused by obesity-related disease is projected to increase from 8% to 10.8% by 2050 due to increasing rates of obesity, diabetes and high cholesterol and other metabolic risk factors.
Dr. Hashem El-Serag, one of the report’s co-authors and chair of the department of medicine at the Baylor College of Medicine in Houston, said the public usually thinks of alcohol as the biggest risk factor for liver cancer.
“I think for most people, if you say cirrhosis, they immediately think of a relative, of someone who was a heavy drinker,” El-Serag said. “I think the vast majority do not make the tie between MASLD, or fatty liver, and cirrhosis and liver cancer.”
MASLD, or metabolic dysfunction-associated steatotic liver disease, affects about 25% of adults in the U.S. It’s caused by a buildup of fat in the liver. About 5% of U.S. adults have a more severe form, called metabolic dysfunction-associated steatohepatitis (MASH), which can lead to scarring, or cirrhosis, of the liver, significantly increasing the risk of cancer.
Excess alcohol consumption can also lead to cirrhosis.
Liver cancer is still relatively rare in the United States, representing 2.1% of all new cancer diagnoses in 2025. The report estimated that by 2040, U.S. rates of MASLD could more than double, affecting more than 55% of adults.
Detecting liver cancer risk factors
Earlier detection and effective treatment plans for MASLD can reduce the risk of obesity-related liver cancer, El-Serag said. The most common treatment is weight loss. GLP-1 weight loss drugs, which include Ozempic and Wegovy, are promising, he said. (A clinical trial published in April found that Wegovy treated MASH in about two-thirds of patients.)
However, people aren’t screened for MASLD like they are for viral hepatitis, El-Serag said.
Dr. Arun Jesudian, a hepatologist and the director of liver quality and inpatient liver services at Weill Cornell Medicine and NewYork-Presbyterian, said patients are tested for MASLD and/or MASH if they have elevated liver enzymes in their blood.
Raising awareness about MASLD among both patients and doctors can lead to more effective testing and diagnosis, Jesudian said.
“I think then we need to make sure that providers who are interacting with these patients are looking at the liver disease component of metabolic syndrome,” he said, referring to patients with a cluster of conditions including high blood sugar, high blood pressure and excess weight. “So checking liver enzymes, that they know how to assess for fibrosis, even based on these blood test scores.”
MASLD and MASH can often be asymptomatic, making self-detection more challenging.
“Right now, it’s haphazard. Some people get tested. Others get suspected. Third, who knows?” El-Serag said.
Dr. Neehar Parikh, a hepatologist at the University of Michigan who specializes in liver cancer, said he is seeing more patients with MASLD as a driving factor for liver cancer.
Patients with MASLD can develop liver cancer without developing cirrhosis, making it even more challenging to detect those cases, Parikh said. Up to 40% of those with liver cancers linked to MASLD don’t develop cirrhosis, according to the report.
Figuring out who those patients are is the “million-dollar question,” he said. “Those patients that develop MASLD that develop liver cancer, you know, how do you screen that population? We don’t really know what to do.”
Still, Parikh said these types of cases are rare.
Ultimately, Jesudian said, “treating these liver diseases early is the best way to prevent liver cancer, because liver cancer almost always occurs in the setting of chronic liver disease.”
