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The epidemiology of liver cancer in Australia

The rates of hepatocellular carcinoma (HCC) are changing across the globe. This reflects a transition in the cause of HCC from viral hepatitis to nonviral causes such as alcohol and metabolic-associated fatty liver disease.1

Here we explore how this is in turn affecting the incidence, mortality and survival rates for people living with HCC in Australia.

What causes hepatocellular carcinoma?

Historically, the main cause of liver cirrhosis was hepatitis B and hepatitis C infections.2
However, the impact of these infections is declining due to both effective hepatitis B and C treatments and hepatitis B vaccination in newborns.2

Unfortunately, this decrease in viral risk factors for HCC is offset by an increase in metabolic risk factors.2,3 These include obesity, type 2 diabetes, metabolic syndrome, and non-alcoholic fatty liver disease (NAFLD).2,3 Alcohol abuse is another common risk factor for the development of HCC.2,3

How common is hepatocellular carcinoma in Australia?

The incidence of hepatocellular carcinoma (HCC) in Australia has been on the rise over the past few decades.4

Between 1982 and 2014, rates of HCC increased from 1.38 cases per 100,000 to 4.96 cases per 100,000.5

Between 1982 and 2019, the incidence of liver cancer (and thyroid cancer) increased more than for any other cancers in Australia.4

Who is most affected by hepatocellular carcinoma?

HCC typically affects those people who are genetic susceptible and exposed to HCC risk factors, in the presence of liver cirrhosis.1

Sex

While the increase in HCC rates has been seen in both men and women, men are more likely to develop HCC than women.

The risk of an Australian male developing HCC is 1 in 70 (1.4%) compared to that for an Australian female, whose risk is 1 in 195 (0.51%).6

HCC Male Female

Age

In Australia, your chance of developing HCC increases with age. It’s estimated that you have a 1 in 103 (or 0.97%) risk of being diagnosed with liver cancer by the age of 85 years.6

Location

Globally, the burden of liver cancer has shifted from the low sociodemographic regions to higher sociodemographic regions. This reflects the transition from viral to nonviral causes of HCC.

However, in Australia, people living in the lowest socio-economic areas are still 58% more likely to be diagnosed with liver cancer and 61% more likely to die from liver cancer than those living in the highest socio-economic areas.4

HCC in Aboriginal and/or Torres Strait Islander people

HCC in Australia affects both Indigenous and non-Indigenous people, however there are significant differences in the epidemiology and outcomes between both groups of people.

Indigenous Australians typically develop HCC at a younger age and are more likely to be female, live rurally, have a lower socioeconomic status and a higher comorbidity burden than non-Indigenous people with HCC.7 Indigenous Australians with HCC are also more likely to misuse alcohol and have hepatitis B and/or diabetes.7
The survival rate for Indigenous Australians with HCC is also poorer compared to that for non-Indigenous Australians. However, this association becomes weaker after adjusting for other factors.7

Deaths from hepatocellular carcinoma

HCC is a leading cause of cancer‐related death worldwide and the rates are also increasing in Australia.8 This is in part due to the increasing incidence of liver cancer.4

In 2023, the number of deaths from liver cancer, were estimated to be 2,545:

  • 871 (34.2%) in females; and
  • 1,674 (65.48%) in males.6
HCC Estimated death

The latest figures show that HCC accounts for about 5% of all deaths from cancer.6,8

In 2021, liver cancer was the seventh most common cause of cancer death in Australia.6 The highest death rates from HCC are seen in the Northern Territory, Victoria and New South Wales.9

What is the survival rate for people with hepatocellular carcinoma?

In Australia, the average life expectancy after diagnosis of HCC is now about one year.10 While this has improved from just over 2 months in 1982,10 HCC remains a low-survival cancer, with the 5-year survival rate reported to be around 23%.6

Notably, HCC is the only low-survival cancer that is rapidly increasing in incidence in Australia.8

This data highlights the need for increased surveillance for HCC, which will help increase rates of early diagnosis and in turn improve treatment outcomes. Surveillance [3] is essential as HCC generally remains asymptomatic until it is very advanced.

Further information

If you want to learn more about the epidemiology of HCC, we recommend the following resources:

Liver Cancer in Australia statistics [4]
Cancer Australia presents the most recent data from the Australian Institute of Health and Welfare.

Australian Cancer Atlas[5]

This interactive atlas allows you to visualise the burden of HCC across Australia. It is a collaboration between Cancer Council Queensland, Queensland University of Technology, and the Cooperative Research Centre for Spatial Information.

Notes

We note that much of the data reported here is for liver cancer (ICD10 C22) which includes both hepatocellular carcinoma and cholangiocarcinoma. However, hepatocellular carcinoma (HCC), is responsible for most liver cancer diagnoses and deaths.2 As such, the terms liver cancer and HCC have been used interchangeably on this page.

References:

1. Toh MR, Wong EYT, Wong SH, et al. Global Epidemiology and Genetics of Hepatocellular Carcinoma. Gastroenterology. Apr 2023;164(5):766-782. doi:10.1053/j.gastro.2023.01.033
2. McGlynn KA, Petrick JL, El-Serag HB. Epidemiology of Hepatocellular Carcinoma. Hepatology. Jan 2021;73 Suppl 1(Suppl 1):4-13. doi:10.1002/hep.31288
3. Singal AG, Kanwal F, Llovet JM. Global trends in hepatocellular carcinoma epidemiology: implications for screening, prevention and therapy. Nat Rev Clin Oncol. Dec 2023;20(12):864-884. doi:10.1038/s41571-023-00825-3
4. Australian Institute of Health and Welfare. Cancer in Australia: In brief 2019. 2019. Cancer series no 122.
5. Lubel JS, Roberts SK, Howell J, Ward J, Shackel NA. Current issues in the prevalence, diagnosis and management of hepatocellular carcinoma in Australia. Intern Med J. Feb 2021;51(2):181-188. doi:10.1111/imj.15184
6. Cancer Australia. Liver cancer. Updated 23 January 2024 Accessed 8 February 2024.
7. Wigg AJ, Narayana SK, Hartel G, et al. Hepatocellular carcinoma amongst Aboriginal and Torres Strait Islander peoples of Australia. EClinicalMedicine. Jun 2021;36:100919. doi:10.1016/j.eclinm.2021.100919
8. Hui S, Bell S, Le S, Dev A. Hepatocellular carcinoma surveillance in Australia: current and future perspectives. Med J Aust. Nov 6 2023;219(9):432-438. doi:10.5694/mja2.52124
9. Cocker F, Chien Yee K, Palmer AJ, de Graaff B. Increasing incidence and mortality related to liver cancer in Australia: time to turn the tide. Aust N Z J Public Health. Jun 2019;43(3):267-273. doi:10.1111/1753-6405.12889
10. Wallace MC, Preen DB, Short MW, Adams LA, Jeffrey GP. Hepatocellular carcinoma in Australia 1982-2014: Increasing incidence and improving survival. Liver Int. Mar 2019;39(3):522-530. doi:10.1111/liv.13966

MC-AU-02918

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