New Delhi: The incidence of highly fatal liver cancers is growing far more rapidly among Indian women than men, although they still strike more men, a new analysis has revealed.
The review titled Epidemiology of Hepatocellular Carcinoma in India — An Updated Review for 2024, published this week in ScienceDirect’s Journal of Clinical and Experimental Hepatology, also showed that a large number of liver cancers — up to 30 percent cases — are now being observed without underlying liver cirrhosis, often considered the precursor to liver cancers.
According to the study, four states in India — Maharashtra, Gujarat, Kerala and Goa — are the new hotspots for hepatocellular carcinoma (HCC), the most common type of liver cancer, which begins in the main type of liver cell per hepatocyte.
Every year, nearly 35,000 cases of liver cancer are reported in the country — the eighth most common type of cancer — with the current incidence rate at 2.15 per 100,000, a prevalence rate of 2.27 per 100,000, and mortality rate of 2.1 per 100,000. Also, there are about 34,000 deaths due to liver cancer annually in the country.
However, the review highlighted that while these rates in the country are lower compared to global data, the annual rates of change in these parameters, including deaths, are higher in India. Globally, liver cancer is the sixth most frequently diagnosed cancer, and causes the third-highest number of cancer-related deaths.
The study noted that by 2025, the global annual incidence of liver cancer is projected to exceed 1 million — or 10 lakh — affected individuals.
The researchers found that the incidence of liver cancers related to hepatitis B, a viral infection, in chronic cases, is on a downtrend. However, cases of those related to alcohol and non-alcoholic fatty liver diseases are rising.
“This review’s primary message is that a high proportion of liver cancers in India are now lifestyle, diet and environment-induced,” Dr Suprabhat Giri, lead author of the analysis and associate professor at Kalinga Institute of Medical Sciences in Odisha, told ThePrint.
The important takeaway, Giri said, is that public health initiatives, awareness campaigns and focused treatments are all necessary to combat the changing epidemiological pattern of the disease in India, particularly in areas with high incidence rates.
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Cause for worry
For a large number of people diagnosed with liver cancer, even at early stages, the five-year relative survival rate is very low — only about 36 percent. If the cancer spreads to surrounding tissues/organs or the regional lymph nodes, the five-year relative survival rate drops to a mere 13 percent.
The latest review included data primarily from the National Cancer Registry Programme by the Indian Council of Medical Research (ICMR), and the Global Burden of Diseases, Injuries, and Risk Factors Study, besides inputs from other studies in India.
It noted that while the northeastern states have higher incidence, prevalence, and mortality related to HCC, Gujarat, Maharashtra, Goa and Kerala are emerging as the newer hotspots with higher annual rates of change in the three parameters.
“This may be due to rapid industrialisation in these places as well as due to other environment-related factors, which need to be examined further,” Giri said.
Traditionally, chronic liver diseases related to the hepatitis B and C viruses have been the most common causes of liver cancers in the Asian continent. However, non-alcoholic fatty liver disease and alcohol misuse are now becoming the foremost reasons for this cancer, the new paper highlighted.
According to Indian estimates, liver cancer was the 11th most common estimated cause of mortality from 2000 to 2019 — the ninth most common among males, and 12th among females. But the researchers concluded that the annual percentage change in incidence from 2000 to 2019 in females was far higher compared to males. The annual rate of change in mortality was found to be 0.52 among males and 0.76 among females.
“Liver cancer mortality trends in India have decreased among men, and increased significantly among women,” the researchers noted.