Over the past 20 years, death rates from all cancers combined in Australia have decreased by around 25%, thanks to improvements in prevention, early detection, treatment and care.
Despite this progress, liver cancer death rates have increased by more than 40%.
How does this occur in a country with a good general track record in cancer control? Why isn't it front-page news? And how can this trend be reversed?
Why is this happening?
Populations impacted by liver cancer are among Australia's most disadvantaged.
The leading risk factors of liver cancer are hepatitis B and C infection.
Hepatitis B
Hepatitis B is prevalent in many low- and middle-income countries. It's bloodborne and commonly transmitted from mother to child. Vaccine protection has been available in Australia since the early 1980s, but not for people infected or many in disadvantaged communities.
Hepatitis C
Hepatitis C is also bloodborne and was not discovered until the late 1980s. The use of injectable drugs led to a spike in infections (which have since lessened due to safer injectable drug use and awareness).
Other liver cancer risk factors include smoking, heavy alcohol consumption and, increasingly, fatty liver disease associated with a higher body weight.
The burden of these risk factors and associated liver cancer falls unfairly on migrant populations, Aboriginal and Torres Strait Islander peoples and people on low incomes. These groups also face barriers to accessing healthcare and they tend to lack a strong consumer voice.
Three intertwined problems - they show established and cyclical disadvantage; preventable and manageable risk factors left unchecked; and a growing but silent patient group.
But we can turn this crisis around.
A roadmap to improved outcomes
In 2019, Cancer Council Australia applied successfully to the Australian Government for funds to develop Australia's first ever roadmap to improved liver cancer outcomes.
The roadmap was developed by the Daffodil Centre's* Gastrointestinal Cancers stream under the guidance of longstanding research collaborator Professor Jacob George and Dr Nicole Allard, a GP and epidemiologist specialising in hepatitis control.
It sets out an evidence-based plan, supported by clinical practice guidelines, with 26 key actions from prevention to end-of-life care, and research priorities to drive ongoing improvements in liver cancer control.
There are effective tests for identifying and supporting people at increased liver cancer risk. For example, blood tests can identify hepatitis B and C infection and ultrasound can detect liver disease that can be a precursor to cancer.
However, evidence doesn't support screening average-risk age cohorts for liver cancer, the way all Australians aged 50 to 74 are invited to screen for bowel cancer every two years. So, the key to the roadmap and guidelines is the implementation and targeted access for people who are most likely to benefit. We urgently need more research into ways to put the roadmap into practice, so that it can be funded and embedded into the health system.
Liver cancer is arguably the starkest example of inequity in cancer outcomes since case and death numbers were first recorded in the late 1960s, and presents a unique challenge.
If we can work as a community to put our research and analysis into practice and drive a decrease in liver cancer death rates, we will change the path of cancer in Australia.
*The Daffodil Centre is a joint venture between Cancer Council NSW and the University of Sydney.
