How common is liver cancer in Australia?

In Australia, both the incidence and mortality rates of hepatocellular carcinoma (HCC) have been increasing over several decades, and the overall 5-year survival rate currently sits at about 23%.^1,2,3

The increasing rates of HCC in Australia are thought to reflect:^2,4

• revised diagnostic criteria;
• an increased at-risk population due to migration; and
• a rise in metabolic dysfunction-associated fatty liver disease due to rising obesity rates.

You can find out more about liver cancer epidemiology here.

Who’s at increased risk of liver cancer?

We know that patients at risk of hepatocellular carcinoma are those with:⁴

• liver cirrhosis;
• chronic hepatitis B or hepatitis C infection;
• alcohol-related liver disease (ARLD); and
• metabolic dysfunction-associated fatty liver disease (MAFLD).

People with cirrhosis make up 85% to 90% of those diagnosed with HCC.¹

HCC is also disproportionately high among Aboriginal and/or Torres Strait Islander people and migrants to Australia from countries where viral hepatitis is endemic.⁴

Why is liver cancer surveillance so important?

Low 5-year survival rates in people with liver cancer are related to many patients being diagnosed with late-stage disease.⁴ Surveillance of our at-risk patients aims to detect HCC early, when curative treatment is still possible.⁴

HCC surveillance programs aim to improve the rates of early detection and curative treatment of HCC, as well as overall survival in people with cirrhosis.⁴

Who should be tested and what tests are needed for people at risk of liver cancer?

Liver ultrasound is the current standard of care for HCC surveillance – in general, testing should be done every 6 months in people at high risk of liver cancer.⁴

A blood test looking for the tumour biomarker alpha-fetoprotein (AFP) can be used in addition to ultrasound to help improve detection rates.^2,4

HCC surveillance in people with cirrhosis

Surveillance should be offered to people with cirrhosis who are:

• willing to have an HCC diagnosis made and consider treatment if HCC is diagnosed;and
• suitable – well enough to receive HCC treatment and with a life expectancy greater than 6 months.⁴

HCC surveillance in people without cirrhosis

Surveillance is also recommended for some people with chronic hepatitis B (HBV) infection without cirrhosis. Factors such as age, ethnicity and family history also need to be considered in these patients.

According to Cancer Council Australia Guidelines, surveillance is generally recommended for the following people with chronic HPV infection without cirrhosis:^2,4

• Asian or Pacific background men aged 40 years or older
• Asian or Pacific background women aged 50 years or older
• Sub-Saharan African people aged 20 years or older
• Aboriginal and/or Torres Strait Islander people aged 50 years or older
• Aboriginal and/or Torres Strait Islander people with a family history of HCC
• Anyone aged 40 years or older with a family history of HCC

See the Cancer Council Guidelines for more detailed information on HCC surveillance.^1,4

Risk assessment for surveillance

Before surveillance is offered, it’s best to perform an individual risk assessment and discuss the risks and benefits with your patient. It’s important to ensure that they are willing to participate in ongoing surveillance.⁴

Patient factors that need to be considered include:⁴

• age;
• family history of HCC;
• individual risk factors;
• ethnocultural group/region of birth;
• comorbidities;
• functioning (ECOG performance status scale); and
• liver-related health status.

Future considerations for surveillance testing

Unfortunately, there are some barriers to surveillance uptake.² The effectiveness of HCC surveillance can also be impacted by the limitations of the current tests and under-recognition of patients at risk.²

In 2023, the Cancer Council and Daffodil Centre published a report called ‘ Roadmap to Liver Cancer Control in Australia’. This document outlines priority actions for targeted screening for advanced liver disease and HCC surveillance.⁵

One of the priority actions identified for primary care is improved systems for surveillance, including patient recall and abnormal-results notification systems.⁵

Future improvements in HCC surveillance may also be achieved with prediction models that identify patients at risk of HCC, and the use of serum biomarkers as an alternative to ultrasound-based HCC surveillance.²

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

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

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.