A “TRIPLE whammy” of obesity, alcohol consumption and Hepatitis C has been blamed as new research revealed that Scotland has the UK’s highest rates of liver cancer, with deaths and diagnoses doubling since the late 1990s.

There are also warnings that the trend is expected to worsen due to the behavioural impact of lockdown on drinking, overeating and lack of exercise, as well as later detection.

While survival rates have improved - and are highest in Scotland - more than half of patients still die within a year of diagnosis.

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Dr Tom Bird, an honorary consultant hepatologist at Edinburgh Royal Infirmary and co-author of the study, said obesity - which can lead to a dangerous build up of fat in the liver - was “without a doubt” the single biggest driver of new cases.

Although there were signs that the rapid increase in cases was levelling off around 2015 across the UK, solid data only goes up to 2017 and Dr Bird said this was not being reflected in hospitals.

He said: “Anecdotally we are no quieter. If anything, we are getting busier, still.

"If you look at data of liver cancer cases over time, there are periods where it seems to flatten out and then increases again.

“Time will tell, but my suspicion is that we’ll continue to see some sort of elevation.

“I’d love it if liver cancer cases would plateau out, but my sense on the ground is that this is not happening.”

The Herald: The increase in incidence of liver cancer appeared to slow around 2015, but it is unclear whether this was sustainedThe increase in incidence of liver cancer appeared to slow around 2015, but it is unclear whether this was sustained

He added: “Obviously, the concern for doctors like me is that what we’re going to see in a few years’ time is only going to get worse because of not tackling obesity in the past, and this secondary effect of lockdown and the impact that’s had on lifestyle.”

The researchers found that between 1997 and 2017, rates of liver cancer in Scotland doubled from 5.83 to 11.71 cases per 100,000, even after adjusting for the ageing population.

By 2017, the incidence in Scotland was 21 per cent higher than the UK as a whole.

The Herald: Dr Tom Bird Dr Tom Bird

Dr Bird said: “[Scotland] may be getting better at detecting liver cancer or better at detecting liver cancer or better at recording it when it happens, but you’ve got to assume that it’s because we have this triple whammy: we do have historically high incidence rates of Hepatitis C; we do have high rates of obesity; and we do have a very poor relationship with alcohol.”

In the late 1990s, only one in four patients in Scotland would be alive one year after diagnosis.

By 2017, nearly half (44.6% ) survived at least one year - compared to 40.6% for the UK as a whole, and 37.7% in Wales - but the surge in cases has offset this improvement.

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As a result, the mortality rate still doubled, from 4.55 per 100,000 in 1999 to 9.79 per 100,000 in 2017 - 30% higher than the UK average.

In 2017, liver cancer claimed 513 lives in Scotland, and rates of the disease across the UK are increasing more rapidly than almost any other cancer type.

The Herald: Plans to restrict price promotions on junk food were put on hold due to the impact of the pandemic on retailersPlans to restrict price promotions on junk food were put on hold due to the impact of the pandemic on retailers

There are some glimmers of hope, however.

Breakthrough antiviral drugs for Hepatitis C, which is most commonly spread between drug users sharing needles, can now permanently eradicate the virus in the vast majority of carriers within weeks.

The Scottish Government has set a target to eliminate Hepatitis C by 2024.

However, while the drugs can drive out the virus and improve liver disease, even in patients with cirrhosis, some will still go on to develop liver cancer.

And while there are signs that minimum pricing has helped to reduce Scotland’s alcohol consumption per head, it still remains the highest in the UK - while public health drives to tackle obesity have been paused.

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Professor Linda Bauld, the Edinburgh University-based cancer prevention expert for Cancer Research UK said the figures were “shocking”.

She urged the next Scottish Government to tackle the “tide of disease caused by carrying too much weight”, adding: "The pandemic understandably stalled progress on new laws to ban the harmful supermarket junk food multibuy offers which encourage us to stock up on unhealthy items that provide no nutritional value.

"But it’s clear from this study that action is still urgently needed to help us all lead healthier lives."

The study is published in the Journal of Hepatology.