What's behind Wisconsin's rising liver cancer rates?

Clinicians like Noelle K. LoConte, MD, a gastrointestinal medical oncologist with the UW Carbone Cancer Center, are leading public health outreach efforts that focus on liver cancer prevention, especially during October, which is Liver Cancer Awareness Month.

“Paul Carbone always said that the best type of cancer is no cancer,” LoConte said, referring to the late oncologist and researcher for whom the Center is named. “Hepatocellular carcinoma doesn’t respond to our treatments very well, and it can affect people when they’re in their fifties and sixties with a lot of life left to live. It would be nice to avoid that.”

The rising rates of chronic infection with hepatitis B and C viruses are among the largest contributing factors to Wisconsin’s growing liver cancer rates. The liver is one of the only organs in the body capable of regenerating damaged tissue, but chronic inflammation from hepatitis infections results in scarring, or fibrosis of the liver. Over time, that scarring becomes permanent—a condition known as cirrhosis. Although antiviral treatments for hepatitis C are very effective, unfortunately, most people do not experience symptoms for years.

“If we only screened people who had symptoms, we would only be catching the tip of the iceberg, and then maybe they’re even too sick to take treatment,” LoConte said.

The cycle of injury and repair in the liver also increases the risk of cancer, especially once an individual has cirrhosis. When liver cells are constantly dividing to replace damaged cells, cancer-causing mutations can sometimes be the result.

LoConte, along with Carbone Cancer Center director Howard Bailey, MD, and their colleagues at MD Anderson, recently co-authored a paper describing the relationship of chronic hepatitis C virus infection and cancer and recommending screening guidelines.

As a blood-borne virus, the most common exposures to the hepatitis C virus are injection drug use as well as having received a blood transfusion before 1992 and the introduction of routine sensitive lab tests on donated blood. This makes baby boomers—the generation born between 1945 and 1965—a high-risk age group for the infection. Current hepatitis C virus screening guidelines from the CDC reflect these risk factors, but LoConte and her colleagues say that oncologists need to both be aware of them and think about them as another aspect of cancer care.

“This is the first time where we have kind of a universal screening recommendation now, for a specific age group—the baby boomers,” LoConte said. “We realized that oncologists were touching a lot of these patients, so we have a role to play in helping to screen and counsel patients to talk to primary care.”

Patients who know about these risk factors for hepatitis C virus can advocate for screening with their primary care provider, LoConte adds.

 Aside from hepatitis B and C virus infection, excessive drinking contributes to the risk of developing liver cancer, as well as other types of cancer. As the principal investigator for the Wisconsin Comprehensive Cancer Control Program, LoConte is part of the group of policymakers, researchers and community members trying to decrease heavy and binge drinking in Wisconsin. This public health group has been raising awareness among the public and healthcare providers about the link between heavy alcohol use and cancer. They are also working to empower communities to implement evidence-based policies—like increased alcohol taxes and regulation on the types of businesses that can legally sell alcohol—to curb high-risk alcohol consumption.

“I believe in the principles of public health,” LoConte said. “I just think it's the right way to move us forward and be a healthier generation.”