Loud and clear message from hepatologists, very combative with the alcohol consumption in Spain. First, a warning: It is already behind more than half of liver cancers. What’s more, alone or associated with other causes, it represents up to 55% of liver cancer cases, the second with the most years of life left. But, in addition, specialists criticize: the evolution of its etiology between 2008 and 2023 “shows the failure of policies to combat alcohol consumption, which remains stable in Spain as the leading cause of hepatocellular carcinoma (HCC)”.
A slap on the wrist on the occasion of the 49th Congress of the Spanish Society for the Study of the Liver (AEEH) which, from February 14 to 16, will be held in Madrid and at which the presence of more than 900 specialists is planned to discuss “the worrying growth of liver pathologies, and their impact at increasingly younger ages , even among young people and adolescents”. They are diagnosed every year in Spain 6,600 new cases of liver cancerhalf of them in very advanced stages, and is the main cause of death in patients with cirrhosis caused by consumption of alcohol or viral hepatitis.
The celebration of this scientific meeting coincides with two important milestones, points out the scientific society. On the one hand, the announcement by the Ministry of Health of a preliminary project to prevent and combat in minors alcohol consumption, which has become “in the public enemy to beat for liver health.” On the other hand, the tenth anniversary of the approval by the European Medicines Agency of the first direct-acting antiviral (DDA) that managed to cure hepatitis C.
At the Madrid Congress The results of the III Registry of Hepatocellular Carcinoma (HCC) will be presented, which collects demographic and clinical data of 767 patients with a diagnosis of primary liver tumor extracted from 52 hospital centers between October 1, 2022 and January 31, 2023. These data, specialists point out, allow us to know the evolution of the etiology of liver cancer over the last fifteen years in our country and show indisputably that alcohol consumption is its primary cause, whether considered in isolation (29.9% of cases) or associated with other causes (54 .9% of cases).
Liver cancer is already the type of cancer that takes the most years of life from the population, specialists warn
This data, the hepatologists say, shows “the failure of the policies to combat alcohol consumptionwho have not been able to reverse the weight of this as the main cause of hepatocellular carcinoma, which remains stable.” This means that almost six out of every ten liver cancers in Spain are due to this substance.
The specialists add that, in addition, there are “two paradoxical and at the same time confluent circumstances: while liver cancer is already the type of cancer that more years of life remain for the populationthe perception of the risks of alcohol consumption remains unchanged in our country, and in fact young people begin their consumption at increasingly younger ages and with patterns associated with greater risk (ingestion of large quantities of alcohol in a few hours). “.
The unstoppable fatty liver
At the same time, the III Registry on Hepatocellular Carcinoma of the AEEH observes an increase in this tumor in people with liver disease in milder stages, without the presence of cirrhosis, which almost doubles, from 4.2 to 7.9% of cases, “and unequivocally shows the growth of liver cancer cases caused by metabolic hepatic steatosis, EHmet, which is what fatty liver pathology is known as.
The increase in cases of fatty liver “is very worrying” to specialists
Compared with the data from 2008 and 2014, the results of the Registry show an increase of almost ten points (1.9% versus 5.9% and 11.8%) in the percentage of hepatocellular carcinomas due to EHmet, which is confirmed as the third cause of liver cancer, and the one that presents faster growththe hepatologists detail.
“This is a trend that worries, and a lot, to specialists, who in fact consider that steatohepatitis will be the leading cause of HCC in a decade, given the advance in the prevalence of fatty liver. In fact, it is estimated that this pathology affects already to more than ten million Spaniards, of which nearly two million would present inflammation of the liver (steatohepatitis) and, of them, 400,000 would already present liver cirrhosis, with the aggravating factor that the majority “They have not yet been diagnosed.”.
An “unstoppable advance” that is worrying “for many reasons and particularly because of the impact it may have on liver cancer.” “The presence of liver cancer in patients with fatty liver in Spain has tripled in the last decade, and with these data it is all said about the magnitude of the problem that we must face,” says the president of the AEEH, Manuel Romero.
The good news”
The “good news,” the specialists conclude on the eve of their scientific congress, is the continued decline in the weight of hepatitis C (HCV) on the total HCC cases, qIt has been reduced in fourteen years from 43% to 17.5%. “A milestone that allowed a 180 degree turn in the history of this infectious disease and that today places our country before the opportunity to achieveuir a great public health achievement: its elimination in just over three decades after the discovery of the virus, for which it will be necessary to carry out a last screening effortparticularly among vulnerable groups,” the doctors point out.
Despite this progression, they clarify, it is still the second risk factor for liver cancer, which is why they “call for a last effort to achieve its eliminationwhich largely involves intensifying screening in vulnerable populations and facilitate access to treatment“.
Furthermore, the data from the III Registry of the AEEH not only show that the epidemiology of liver cancer is changing, but also that the effort to increase detection “with screening programs is not proving sufficient.” In this sense, they highlight that the proportion of patients with cirrhosis diagnosed with cancer in screening programs has not changed and, therefore, “fails to take off.” In the present moment, 43% of cases are detected outside of these programs.
The problem, doctors say, is that when the diagnosis of hepatocellular carcinoma is carried out outside of screening, disease it’s found in a more advanced phase where they are least likely to be offered a curative treatment, which results in a significantly worse prognosis. These results indicate the need to improve liver cancer screening programs.