Liver cancer on the rise: Canadians need to know the risk factors for this largely preventable cancer

29 May 2013

TORONTO –

Liver cancer is one of the fastest rising of all cancers in Canada, yet most Canadians do not know enough about risk factors and prevention, according to Canadian Cancer Statistics 2013, released today by the Canadian Cancer Society in collaboration with the Public Health Agency of Canada and Statistics Canada.

Since 1970, the incidence rate of liver cancer has tripled in Canadian men and doubled in Canadian women, rising every year by 3.6% in men and 1.7% in women.

Liver cancer has a very poor prognosis, with a 5-year relative survival rate of only 20%. While it is still a relatively rare cause of death in Canada (1,000 deaths expected this year), the death rate in Canadian men has doubled since 1970. And worldwide it is the 3rd leading cause of cancer death after lung and stomach cancer, accounting for about 700,000 deaths per year.

The main risk factors for liver cancer are chronic hepatitis B and C infections. However, hepatitis is not well recognized as a serious health threat. In addition, many people don’t know that they have hepatitis. Approximately 600,000 Canadians are infected with hepatitis B or C, according to the Public Health Agency of Canada.

Heavy alcohol use, obesity, diabetes, smoking and several other factors are also associated with a higher risk of liver cancer.

If more isn’t done to address the risk factors for liver cancer, incidence and death rates are expected to continue to rise in Canada.

Recommendations from the report

To lower the rising rates of liver cancer cases and deaths, it will be important to:

• Find and treat people who have hepatitis B or C. This can reduce progression to chronic infection, which can lead to cancer.
• Encourage primary healthcare providers to offer the hepatitis B vaccination or appropriate testing and treatment for hepatitis B or C to at-risk people, including newcomers to Canada if they come from parts of the world where hepatitis B, hepatitis C or liver cancer are common.
• Raise awareness among Canadians about the risk factors for liver cancer, especially its links with hepatitis B and C, how to reduce the risk of liver cancer and how to get tested and treated for hepatitis infection if they belong to an at-risk group.
• Encourage primary healthcare providers to counsel patients about alcohol use, maintaining a healthy weight and not smoking, which can reduce the risk of liver cancer, in addition to having other health benefits
• Conduct more research in Canada about the most effective ways to educate the public about the disease and to better understand the needs of liver cancer patients and survivors.
• Have more Canadian data to understand the best strategies for hepatitis B and C screening, and how best to engage communities in promoting screening for hard-to-reach populations.

“It’s important to draw attention to the rising incidence and death rates for liver cancer so that we can tackle this important public health problem,” says Dr Prithwish De, epidemiologist with the Canadian Cancer Society and the lead author of the special topic on liver cancer. “The good news is that liver cancer is largely preventable by modifying risk factors.”

More about liver cancer in Canada

• In 2013, it is estimated that there will be over 2,000 new cases of liver cancer and about 1,000 deaths from the disease.
• The incidence rate is higher in Canadian men at 6.9 cases per 100,000 than in Canadian women at 1.9 cases per 100,000.
• Liver cancer is challenging to identify and treat because there are usually no symptoms until its later stages when the prognosis is poor. As a result, the death rate is high and the 5-year relative survival rate is low.
• Treatment can involve surgery, radiofrequency ablation, chemotherapy and/or radiation.
• Worldwide, liver cancer is the 6th most commonly diagnosed cancer. In Canada, liver cancer is a rare but rising cancer.

More about hepatitis B

Hepatitis B infection accounts for about one-quarter (23%) of liver cancer cases in developed countries, but the percentage is much higher in parts of the developing world where hepatitis B is common, such as eastern Asia and sub-Saharan Africa.

• Hepatitis B can be prevented with a vaccine. All provinces in Canada offer universal vaccination against this form of hepatitis, although the vaccination strategies vary from province to province. Some provinces offer universal vaccination to newborns, while other provinces offer universal vaccination to adolescents.
• The hepatitis B virus is commonly passed through exposure to contaminated blood or body fluids between sexual partners, by sharing needles among drug users or by sharing personal care articles, such as razors, scissors, nail clippers or toothbrushes, with an infected person.

More about hepatitis C

• Hepatitis C infection accounts for approximately 30%–50% of liver cancer cases in North America. The percentage is lower in the developing world.
• There is currently no vaccine to prevent hepatitis C.
• In Canada, the hepatitis C virus is spread through exposure to contaminated blood and is sometimes transmitted through sexual activity.
• Those at highest risk for infection include:
  • injection drug users
  • immigrants from regions where hepatitis C is common, such as southern Europe, and parts of Africa and Asia, where transmission can occur through medical procedures using unsterilized equipment
  • people exposed occupationally to contaminated blood, such as nurses
  • Aboriginal people
  • recipients of blood transfusions before the implementation of blood screening for hepatitis C in Canada

General highlights – Canadian Cancer Statistics 2013

• Over the past 30 years, the death rate for all cancers combined has been declining for males in most age groups and for females in all age groups, except over 70.
• There were no increases in death rates for most types of cancer in men and women, with the exception of liver cancer in both sexes and lung cancer in women.
• The age-adjusted 5-year relative survival rate for all cancers combined in 2006–2008 was 63%, an improvement over the survival rate of 56% in 1992–1994.
• An estimated 187,600 new cases of cancer (excluding 81,700 cases of non-melanoma skin cancer) and 75,500 deaths from cancer are expected to occur in Canada in 2013.
• Rates of the disease are generally stabilizing for new cases and declining for deaths. However, the number of new cancer cases and cancer deaths continues to rise as the Canadian population grows and ages. Four types of cancer – lung, breast, colorectal and prostate – account for 52% of newly diagnosed cancers.

“Cancer, in all its forms, touches each and every one of us,” says Minister of Health Leona Aglukkaq. “Fighting cancer is a priority for our government and that is why every year we invest in research and the Canadian Partnership Against Cancer. The Public Health Agency of Canada is pleased to work with the Canadian Cancer Society to increase public awareness about cancer prevention and control.”

“Cancer, in all its forms, touches each and every one of us,” says Minister of Health Leona Aglukkaq. “Fighting cancer is a priority for our government and that is why every year we invest in research and the Canadian Partnership Against Cancer. The Public Health Agency of Canada is pleased to work with the Canadian Cancer Society to increase public awareness about cancer prevention and control.”

 Canadian Cancer Statistics 2013 was prepared through a collaboration of the Canadian Cancer Society, the Public Health Agency of Canada, Statistics Canada and provincial and territorial cancer registries.

Media backgrounder #1: Highlights of 2013 liver cancer statistics
Media backgrounder 2 Canadian Cancer Statistics 2013

For 75 years, the Canadian Cancer Society has been with Canadians in the fight for life. We have been relentless in our commitment to prevent cancer, fund research and support Canadians touched by cancer. From this foundation, we will work with Canadians to change cancer forever so fewer Canadians are diagnosed with the disease and more survive. Visit cancer.ca or call us at 1-888-939-3333 (TTY 1-866-786-3934).