Liver cancer threat looms as higher infection rates collide with specialist shortage

by Leo Almazora18 Jun 2018

Mortality rates for most major cancers like breast and lung cancer are declining, but one particular type has bucked the trend — and could become an epidemic unless several troubling developments are reversed.

“In 1993, liver cancer rates in Canadian men were five cases per 100,000 population,” wrote Morris Sherman, an affiliate scientist with the Toronto General Hospital Research Institute and Emeritus Professor at the University of Toronto. “By 2017 this had risen to 9.9 cases.”

Women are seeing lower rates but on a parallel trajectory, with 1.6 cases per 100,000 in 1993 having almost doubled by 2017. The pattern is mirrored in other developed like the US, the UK, and Australia, but the threat is particularly acute in Canada because of several colliding trends.

“Today, there are an estimated 230,000 Canadians with hepatitis B and 250,000 with hepatitis C,” Sherman explained. “Almost half of each group do not know they are infected, which hugely increases their risk of progression to serious liver disease and cancer.”

Another issue contributing to the risk is Canada’s obesity epidemic. Referring to figures from Statistics Canada, he said around two thirds of Canadian men and half of women are thought to be overweight or obese. He also cited statistics from the Canadian Liver Foundation indicating that one in five Canadians have some degree of non-alcoholic fatty liver disease (NAFLD), which causes inflammation and can lead to cirrhosis and liver cancer.

All this comes as the country faces a dearth of specialists to deal with the disease. In 2017, less than 100 liver specialists and a few oncologists handled some 5,000 cases of liver cancer. Also concerning is the fact that graduating liver specialists —known in the profession as hepatologists — tend not to specialise in liver cancer, and it’s not a popular specialty among oncologists either.

The trends in hepatitis B and C incidence, according to Sherman, would translate to numbers in the tens of thousands over the next two decades. “We are completely unprepared to deal with such an epidemic of liver cancer,” he said. “[T]he financial considerations for provinces and territories and the federal government would be phenomenal.”

Sherman called on provinces and territories to review the remuneration for liver specialists, who tend to be not as well compensated as those in other specialities. He also noted the possible need to develop special programs that would boost recruitment into the field.

He also noted that liver cancer rates in Canada are much lower than those in other developed nations. Suggesting that this small victory is due to the country’s “excellent record in finding cases of liver cancer very early,” he said more hepatitis B and C patients must be diagnosed and treated or cured. He added that new therapies within the next decade would also result in much better care and prognosis for hepatitis B.

“Finally, because obesity in Canada shows no signs of retreating, we will be dependent on new treatments in the pipeline for fatty liver disease,” he said.

 

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