Latest news with #BrianP.Lee
Boston Globe
29-07-2025
- Health
- Boston Globe
Three out of five liver cancer cases are preventable, study finds
Advertisement The findings align with what liver specialists have seen in their clinics for years. 'Liver cancer is common, it causes immense suffering and death, and the saddest part for me as a physician is that most of the cases are preventable,' said Dr. Brian P. Lee, an associate professor of medicine at the Keck School of Medicine at the University of Southern California, who was not involved in the study. Improved screening, vaccination and treatment in recent years have helped stem viral hepatitis, especially in the United States. But the threat of liver cancer from heavy alcohol use and metabolic dysfunction-associated steatotic liver disease, or MASLD, formerly known as nonalcoholic fatty liver disease, 'has been underrecognized and underestimated,' said Dr. Ahmed Kaseb, a professor of gastrointestinal medical oncology at the University of Texas MD Anderson Cancer Center, who was not associated with the study. Advertisement A 'highway' to liver cancer A vast majority of liver cancers arise in people with cirrhosis, said Dr. Hashem El-Serag, the chair of the department of medicine at Baylor College of Medicine in Texas and one of the authors of the new study. Cirrhosis, or advanced and largely irreversible scarring of the liver, damages healthy tissue and prevents the organ from working normally. The hepatitis B and C viruses cause inflammation that, if left untreated, can scar and damage the liver, potentially leading to cirrhosis. And both alcohol and metabolic dysfunction lead to abnormal deposits of fat in the liver, which can also result in inflammation. Related : Lee said the accumulation of fat and inflammation acted as a 'highway' to liver scarring, which in turn can injure DNA and lead to cancer. 'There could be multiple ramps to get onto that highway,' he said. Why disease may go undetected The new paper found that the share of liver cancers resulting from hepatitis B and hepatitis C is expected to drop to 63% in 2050, from 68% in 2022. But the burden of liver cancers resulting from alcohol and MASLD is expected to grow. An estimated 4 in 10 adults worldwide have MASLD, a condition in which fat builds up in the liver. Risk factors include obesity and Type 2 diabetes. A subset of patients with MASLD will go on to develop an advanced form called metabolic dysfunction-associated steatohepatitis, or MASH, which has been described as a silent killer because it can progress to cirrhosis and liver cancer without being noticed. Current guidance recommends monitoring for liver cancers in patients who have a history of viral hepatitis or established cirrhosis. Patients with MASH typically don't meet that criteria, Kaseb said, but they could have liver scarring without symptoms, and nobody would know. Related : Advertisement That's why screening for liver disease needs to begin at the primary care level, where cases can easily go undetected, said Dr. Mary Rinella, a hepatologist at University of Chicago Medicine and the lead author of guidelines for the management of MASLD. She recommended that doctors use a metric called the Fib-4, which uses routine blood test results to estimate the amount of liver scarring, to screen high-risk patients. These include people who have Type 2 diabetes or obesity with at least one other metabolic risk factor, such as high cholesterol. MASLD is reversible with lifestyle changes, including a healthy diet and increased exercise, and weight-loss drugs have recently been shown to be effective at reversing scarring as well. 'If you stop the reason or the impetus for scarring and injury in the liver, then you're going to have less impetus for the development of cancer,' Rinella said. Alcohol compounds the problem Alcohol-related liver disease is also on the rise. In research published this month, Lee and his colleagues showed that the risk of alcohol-related liver disease among heavy drinkers (at least 10 drinks per week for women and 15 for men) in the United States more than doubled between 1999 and 2020, despite similar alcohol use over that period. That suggests that heavy drinkers today may be more sensitive to the effects of alcohol on the liver than those in the past, Lee said. This may be because the population of heavy drinkers is changing. The researchers found that women, who are more prone than men to develop fat and damage in the liver from alcohol, now make up a greater share of heavy drinkers than they did 20 years ago. So do people with metabolic syndrome, a cluster of metabolic disorders that together raise the risk of diabetes, heart disease and stroke — and compound the damage done by alcohol to the liver. Related : Advertisement Drinking heavily and having a metabolic condition such as obesity can independently damage the liver, but patients who fall in both categories are at an especially high risk. These trends are likely to continue. 'Alcohol use is increasing,' Rinella said. 'Obesity and diabetes are increasing.' 'I expect that we're going to continue to see a high burden of liver disease,' she added. This article originally appeared in .
Los Angeles Times
26-07-2025
- Health
- Los Angeles Times
Serious liver disease is up among heavy drinkers, even without more drinking
Serious liver disease is becoming more common among Americans who drink heavily, according to a new study from Keck Medicine of USC. It's not that more people are partying with alcohol. And it's not that the drinkers are having more drinks. It's that more of the people who drink regularly are becoming sick. Over the last two decades, the share of heavy drinkers who have advanced liver scarring jumped from 1.8% to 4.3%. For women, more than 1.5 drinks per night, on average, is considered heavy drinking. For men, it's 2 drinks. 'The fact that the risk not only increased but that it more than doubled — almost tripled — is really astonishing,' said Dr. Brian P. Lee, a liver transplant specialist at Keck Medicine of USC and lead author on the study. It was published in the journal Clinical Gastroenterology and Hepatology on Wednesday. Lee said he thinks patients might dramatically change their thinking and behavior if they had this information. The increase in illness was seen especially in women, older people and those with conditions like obesity or diabetes. Three USC researchers analyzed national health data from more than 44,000 adults surveyed between 1999 and 2020 in a well-known national heath study known as NHANES. Of those, 2,474 were heavy drinkers according to the definition of the National Institute on Alcohol Abuse and Alcoholism — 20 grams of alcohol per day for women and 30 grams for men, roughly the equivalent of 1.5 and 2 drinks. They found a more than twofold increase over the two decades in significant liver fibrosis, a condition where healthy liver tissue is replaced by stiff, fibrous tissue — like a sponge hardening into leather. If left unchecked, this can eventually lead to liver failure or cancer. By comparison, non-heavy drinkers saw a much smaller increase, from 0.8% to 1.4% over the same period. This rise in liver damage is especially troubling because many people don't realize anything is wrong until the disease is advanced. 'Liver disease is silent,' Lee said. 'Most people won't, even if they have [advanced liver scarring], have any symptoms at all.' Drinking patterns did not change much over the study period. But the health profiles of heavy drinkers did. Rates of metabolic syndrome — a cluster of conditions including obesity, diabetes, and high blood pressure — increased from 26% of people, to nearly 38%. Demographics shifted too: heavy drinkers became more likely to be women, people over the age of 45, and those living in poverty. 'We're showing with this study that the picture of the American drinker is changing dramatically,' Lee said. 'You have more women who are drinking heavily, more ethnic minorities who are drinking heavily, and these are groups that are known to have a higher sensitivity to alcohol in causing liver damage.' Other factors may also be at play, said Dr. Sammy Saab, medical director of the Pfleger Liver Institute at UCLA, who was not involved in the study. People could be consuming different types of drinks, or at different times. 'Have we moved away from beer, wine, to hard cocktails? Have we moved away from drinking with food, where the food absorbs some of the alcohol you consume, versus drinking without food where alcohol is better absorbed?' Saab asked. Then there are cultural changes, he said. 'In the old days, if you drank, you'd still have to drive home, but now we've got Uber, we have Lyft,' he said, which may remove some deterrents to heavy drinking. The current definition of heavy drinking in the U.S. may actually be too lenient, Lee said, especially compared to evolving global standards. Canada, for example, now advises no more than two drinks per week to minimize health risks. 'In the U.S. right now, we consider heavy drinking to be eight drinks or more per week for women and 15 or more for men — but that's quite high,' he said. 'We've shown in prior studies that you can develop liver disease at lower quantities than the U.S. threshold.' The study's findings highlight the need to rethink long-held assumptions about alcohol-related liver disease, and Lee hopes it can be used to develop more effective screening methods for early detection. The paper raises a lot of good questions, Saab said, serving as a call to action for researchers and clinicians to better understand this increase in alcohol-associated liver disease — and how to stop it.
