Liver disease in Canada has been growing exponentially but largely off the public radar. Ten years ago, estimates were that 1 in 10 Canadians might be affected by liver disease. Today, that number is 1 in 4. Individuals, health care institutions, and policy makers should find this alarming. While liver disease can often be slow moving, our aging population means that those that have been living with chronic — ­­­and in many cases undetected — liver disease are progressing to more advanced complications like liver cancer.

Cancer rates are well-documented in this country but liver disease statistics are not. Liver cancer is the only cancer for which the incidence and death rate are rising. Liver cancer rates can therefore serve as a barometer indicating the general state of liver health in Canada. What they are predicting is a “high” in end-stage liver disease. We’re already seeing this trend in hospital admission data. At the University Health Network in Toronto, 30 percent of admissions to the general medicine ward are for complications of end-stage liver disease, which also account for 50 percent of admissions to the ICU in Edmonton.

Liver cancer can be the end result of many forms of liver disease. Since 1970, liver cancer cases have tripled for men and doubled for women. But the causes of liver cancer are changing. In 1995, about 50 percent of liver cancer was the result of hepatitis B. Today that number is just 22 percent, and it’s destined to drop even further due to the impact of the last two decades of neonatal and school-based immunization programs. Unfortunately, the balance has shifted to hepatitis C and fatty liver disease. Hepatitis C is now responsible for 38 percent of liver cancer cases (up from 25 percent), and fatty liver disease — both alcoholic and non-alcoholic — accounts for 36 percent. The incidence of liver cancer from hepatitis C and fatty liver disease is destined to grow. For hepatitis C, this growth period may only last 10 years or so as treatment rates rise but with obesity and diabetes levels continuing to sky rocket, we can expect liver cancer rates due to fatty liver disease to balloon. With this comes an inevitable increase in demand for acute care – a situation that provinces are unprepared for.

The news is not all bleak, however. We have made great progress in our ability to prevent, manage, treat, and even cure the liver diseases that can lead to liver cancer. We are also continually improving our ability to diagnose and intervene in liver cancer. One of the exciting projects the Canadian Liver Foundation is helping to fund is looking at the potential of nanoparticles to knock out liver cancer’s defenses so it can be eliminated by the immune system. Other research is looking at the DNA of liver tumours as a way of predicting prognosis and treatment outcomes.

Increasing treatment options and efficacy for liver cancer patients will help save lives but we need equal emphasis on prevention. If we can effectively reverse the trends related to liver cancer, we will improve long-term liver health for all Canadians.

Dr. Morris Sherman is the Chairperson of the Canadian Liver Foundation and a liver specialist at Toronto General Hospital. To learn more about the CLF and liver disease, visit www.liver.ca