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Evidence-Based Oncology October 2019

NASH and Liver Cancer: The New Cancer Headline

Donna Cryer, JD
The most common primary liver cancer, hepatocellular carcinoma, is driven by fatty liver disease and is among the most prevalent and deadly of cancers driven by obesity. Rising rates of overweight and obesity parallel increased rates of obesogenic cancers, which increased 7% between 2005 and 2014.
The Liver Illness Visibility, Education, and Research (LIVER) Act of 2019 (HR 3016), introduced in May, is crucial to progressing liver cancer research.17 The LIVER Act will authorize funds for liver cancer and hepatitis B research at the National Institutes of Health and elevate the Liver Diseases Branch of the National Institute of  Diabetes and Digestive and Kidney Diseases to a division. The act would also direct the National Cancer Institute to establish an interinstitute working group and create programs to coordinate research agendas focused on finding better outcomes and cures for liver cancer and other liver diseases. In addition, the act authorizes funds for prevention and awareness grants at the CDC, including grants for screening, vaccination, and treatment for liver cancer, NAFLD, and cirrhosis of the liver.

Another step forward in health policy comes from Hawaii, where Hawaii House Bill 654 was signed into law.18 It appropriates funds to the University of Hawaii Cancer Center in Honolulu to determine the etiologies of the high incidence of liver and bile duct cancer in the state and establishes reporting requirements. The bill also highlights NASH as a cause of liver cancer.

More research is needed to understand the relationship between the NAFLD and NASH epidemic and liver cancer incidence and mortality trends so that more can be done to elevate and, ideally, solve these related health problems. Peter Campbell, PhD, strategic director of gastrointestinal tract cancer research at the American Cancer Society states, “Along with reducing known risks—excess alcohol consumption and hepatitis infection—maintaining a healthy body weight, eating healthy, and staying physically active to reduce the risk of diabetes may be important preventive strategies to reduce the risk of liver cancer.”8

If policy and research trends continue in the right direction, we expect to see liver cancer diagnoses and deaths steadily decrease. But this won’t come without widespread public awareness and education on liver cancer, NAFLD, and NASH. Looking forward, policy makers, thought leaders, research experts, clinicians, and patients must come together to change the narrative of liver cancer and alter the trajectory of this disease while saving lives.

Author Information

Donna R. Cryer, JD, has channeled her personal experience as an irritable bowel disease and liver transplant patient into professional advocacy as founder of CryerHealth, LLC consulting firm on patient–industry partnerships; the Global Liver Institute (GLI), the only patient-driven liver health non-profit operating in the United States and Europe; and now as interim executive director of the People-Centered Research Foundation, the central office for PCORnet. In addition to leading the GLI Liver Cancer Council, Cryer’s oncology experience includes serving as a managing director for the Association of Community Cancer Centers, building a multicultural clinical trial recruitment function for a public relations agency, and assessing patient advocacy and public affairs capabilities and opportunities for top pharmaceutical clients in the oncology space. She is a frequent speaker on patient centricity in research and healthcare delivery at meetings of major pharmaceutical, biotechnology, and oncology research and industry organizations.
References

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4. Definition & facts of NAFLD & NASH. National Institute of Diabetes and Digestive and Kidney Diseases website. niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts. Published November 2016. Accessed August 21, 2019.
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13. Global Liver Institute. Beyond the biopsy. static1.squarespace.com/static/53bafd3ce4b0ae714af7153f/t/5cdc83aec1536000011c0e85/1557955502787/btb-2019.pdf. Accessed September 3, 2019.
14. Non-invasive biomarkers of metabolic liver disease. Foundation for the National Institutes of Health Website. fnih.org/what-we-do/biomarkers-consortium/programs/nimble. Accessed September 3, 2019.
15. Antsee QM. LITMUS: Liver Investigation: Testing Marker Utility in Steatohepatitis. HIV Forum website. hivforum.org/storage/documents/2016/LF5/08_Anstee.pdf. Published August 2016. Accessed September 3, 2019.
16. 16. NCI funds SPORE for liver and bile duct cancer research. Forefront. March 2019, mayo.edu/research/forefront/nci-funds-spore-for-liverand-bile-duct-cancer-research. Accessed September 3, 2019.
17. Liver Illness Visibility, Education, and Research Act of 2019, HR 3016, 116th Cong, 1st Sess (2019). HB 654, 30th leg (HI 2019).
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