FOR the past year there has been an almost daily count of deaths from Covid-19. These grew as the pandemic progressed and just under 10,000 families across Scotland have lost loved ones to this disease. But other causes of death have not disappeared and are no less important.

Cancer is and remains Scotland’s biggest killer, accounting for around 16,000 deaths per year. Huge progress has been made in reducing cases and deaths for some types of cancer, with two in four people surviving cancer for at least ten years. But this has not been the case for liver cancer. Although this cancer is not common, a diagnosis can be devastating for the individuals and families involved. It remains the fourth leading cause of cancer deaths in the world.

A new study published this week from researchers across Great Britain, led by Public Health England and the British Association for the Study of the Liver, examined trends in liver cancer incidence, deaths and survival from 1997-2017. Although some improvements in survival were found, the number of liver cancers increased. The study found that the incidence of liver cancer has doubled over the past 20 years and Scotland has the highest rate of liver cancer deaths in the UK.


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Dr Tom Bird from the Cancer Research UK Beatson Institute and the University of Edinburgh is one of the authors of this new research. I discussed the study with him and what can be done to try to reverse these trends in Scotland. He explained that liver cancer often develops without symptoms until a late stage when treatment options are limited. On average, fewer than 10% of liver cancer patients survive longer than five years after diagnosis. This makes prevention particularly important. There are several types of liver cancer, but the most common, hepatocellular carcinoma (HCC), is caused by factors like Hepatitis C infection, too much fat within the liver due to overweight and obesity and alcohol consumption.

While Scotland has made huge strides in reducing rates of Hepatitis C, we still have the highest rates of overweight and obesity and alcohol consumption in the UK. This probably explains much of our unenviable position on liver cancer deaths compared to the other UK nations. So what more can we do to address these risk factors?

Progress has been made on tackling harmful drinking here with the introduction of minimum alcohol pricing that increased the price of the highest strength and most affordable drinks bought in the retail environment. Studies have found that minimum pricing resulted in a reduction in the amount of alcohol purchased by households in Scotland, particularly those that bought the most alcohol. It also contributed to reductions in alcohol consumption at a population level and a notable fall in deaths from alcohol misuse in 2019.

Whether this drop will be maintained remains to be seen as a number of surveys show notable rises in drinking among certain groups during the coronavirus pandemic. This may pose challenges for assessing the longer-term impact of minimum pricing and highlights the need for additional measures to address alcohol harms including better access to treatment and support, and action on alcohol advertising.

Perhaps the largest preventable risk factor driving increases in liver cancer is obesity. Two in three adults in Scotland are living with being overweight or obese and rates have increased in recent years in more deprived communities. The Scottish government published a diet and healthy weight delivery plan in 2018 but implementation of this stalled during the pandemic, despite the fact that the links between Covid-19 and obesity are now clear. In particular, legislation to restrict multi-buy offers on unhealthy products has not been introduced.

As Cancer Research UK and others have argued, progress on this needs to be urgently accelerated. We also need better access to weight management services in Scotland, and wider measures at UK level to prevent obesity including in children, such as restrictions on junk food marketing on television and online.

Beyond prevention, we need to support and invest in the diagnosis and treatment of liver cancer. Dr Bird explained that screening for this disease is applied routinely throughout Scotland for patients known to be at risk, but there remain major opportunities to improve screening and engage those with as yet unknown significant liver disease who are at risk.

While early stage liver cancer is often curable, the treatment options for the majority of patients with late stage cancer are much more restricted and less effective, typically offering only a few extra months of survival. But in the last decade we have seen significant and exciting advances in the range and effectiveness of cancer treatment options for this disease.


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Despite the current rise in liver cancer, we have considerable strength in liver cancer research and clinical trials in Scotland. Research can pave the way in the future for better chances of cure for a wider range of patients. Scotland led the way in data collection for Hepatitis C in the last century. This heralded a revolution in treating patients who were living with what was then an incurable condition. People diagnosed today with Hepatitis C have an excellent chance of recovery.

We should be able to do the same in the future for liver cancer. But to do this we still need to improve our already strong networks of doctors and scientists. By introducing policies that can address key risk factors for liver cancer and building upon the existing powerhouse for liver cancer research we have in Scotland, we are in a strong position to turn the tide on this disease.

Professor Linda Bauld is Chair of Public Health at the University of Edinburgh.

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