The causes of liver cancer are changing worldwide, with fewer cases resulting from viral hepatitis and more cases related to fatty liver disease or alcohol use. Liver cancer is often diagnosed late, when it is difficult to treat, and it is among the fastest-rising causes of cancer death in the United States.

Using data from the Global Burden of Disease study, Rohit Loomba, MD, of the University of California San Diego School of Medicine, and colleagues estimated that there were 534,000 new cases of liver cancer and 485,000 liver cancer deaths worldwide in 2019. This represents a 27% increase in liver cancer incidence and a 25% increase in mortality since 2010. Yet after adjusting for age, worldwide incidence and death rates did not change significantly—except for a sharp rise in the Americas.

Liver cancer deaths related to viral hepatitis declined worldwide thanks to widespread hepatitis B vaccination and treatment and effective therapy for hepatitis C. Direct-acting antiviral (DAA) medications can cure more than 90% of people with hepatitis C. One recent study found that as cure rates increased over time, liver cancer outcomes also improved. Five-year survival rates rose from 59% during 1999–2005 to 78% during 2014–2019, after the advent of modern DAAs. But a recent analysis from the Centers for Disease Control and Prevention found that less than one third of people with hepatitis C in the United States receive timely treatment.

During this time, advanced fatty liver disease (non-alcoholic steatohepatitis, or NASH) became the fastest-growing cause of liver cancer death worldwide, likely due to rising obesity rates, and alcohol use was the second fastest-rising cause. “Urgent measures are required at a global level to tackle underlying metabolic risk factors and slow the growing burden of NASH-associated liver cancer, especially in the Americas,” the study authors wrote.