Incidence has quadrupled in 40 years while survival remains stuck at 22%. Without a national surveillance program, they warn the gap will only widen.
Despite major strides in overall cancer survival, primary liver cancer remains a deadly outlier in Australia.
Over the past four decades, its incidence has increased more than four-fold, rising from 2.2 cases per 100,000 in 1982 to 10.1 in 2019. No other cancer has grown at this rate. Hepatocellular carcinoma (HCC) accounts for more than 85% of these cases, yet five-year survival languishes at just 22%, among the lowest of any cancer type.
In a perspective published this month in the Medical Journal of Australia, experts examined the preventative health initiatives in some east Asian countries that have seen impressive reductions in HCC mortality over the past two decades.
They said new strategies were urgently needed to reduce deaths from liver cancer in Australia.
“Other countries have demonstrated what is possible. In Japan, a comprehensive national HCC surveillance program established in the 1980s, integrated with viral hepatitis screening, has transformed outcomes,” the authors wrote.
“Regular public education campaigns, a national registry, and the use of advanced biomarkers such as AFP-L3 and PIVKA-II have dramatically improved early detection. Japan’s five-year survival has risen from 5% in 1980 to 58% in 2013.
“Australia lacks such a system. While national screening programs exist for breast, bowel and cervical cancer, there is no equivalent for chronic liver disease or HCC.
“Experts argue that a coordinated approach, combining liver disease assessment in primary care, funding for non-invasive fibrosis testing, and a national registry with structured imaging protocols, is essential.
“Emerging evidence supports the addition of blood-based biomarkers such as GAAD, which combines gender, age, AFP and PIVKA-II, to improve accuracy and overcome barriers in remote regions where imaging is limited.”
International guidelines recommend six-monthly liver ultrasound scans, with or without AFP blood testing, for individuals at risk of HCC.
Surveillance improves survival and is cost-effective, yet Australian uptake is poor, the perspective authors wrote.
Recent data from Melbourne reveal virtually no improvement in the past decade; only 39% of HCC cases were detected through surveillance in 2022, similar to 40% in 2013.
“The reasons are clear – low awareness among both clinicians and patients, the silent progression of chronic liver disease, cost and access barriers, and an absence of national coordination,” they wrote.
Related
“For First Nations Australians and those experiencing socioeconomic disadvantage, the burden is even greater.”
HCC is almost always associated with chronic liver disease, and in most cases, cirrhosis. Once driven mainly by viral hepatitis and alcohol-related liver disease, the disease landscape is shifting.
Metabolic dysfunction-associated fatty liver disease (MAFLD), linked to obesity and diabetes, was emerging as a dominant cause. Unlike many cancers, the population at risk is well defined, and early detection offers the chance of cure through surgical resection, ablation or liver transplantation, the authors wrote.
The experts argued for a national, multi-pronged strategy, underpinned by five key actions including:
- Nationwide awareness and health promotion campaigns in partnership with community organisations to address stigma and reach culturally diverse and First Nations populations.
- Funding for chronic liver disease assessment in primary care, including Medicare rebates for non-invasive fibrosis testing (such as FibroScan).
- Creation of a national HCC registry and surveillance program using a hub-and-spoke model to overcome geographic barriers.
- Integration of blood biomarkers like GAAD (Gender, Age, AFP, PIVKA-II) alongside ultrasound for better accuracy and accessibility — especially critical in remote areas where imaging is limited.
- Setting measurable national targets for liver disease detection, HCC surveillance uptake, and mortality reduction.
“Setting national targets in disease management helps galvanise policy action and investment towards achieving these goals, as demonstrated by the World Health Organization 2030 viral hepatitis global targets set for testing, linkage to care, treatment and mortality, which informed the hepatitis B and C strategy targets in Australia,” the authors wrote.
“Such aspirational goals should be set for the cascade of care in primary liver cancer as part of the Australian Roadmap to Liver Cancer Control to improve survival in HCC.”
The researchers concluded that while Australians had access to advanced treatments for HCC, the potential for curative outcomes was limited by how early cancer is detected.
“Adopting health policy change that increases assessment for liver disease and cirrhosis in primary care, coupled with a strong, funded national HCC surveillance program using ultrasound and blood biomarkers is vital to reduce deaths from HCC,” they wrote.
