Preventable liver cancer cases through reduced exposure to overweight/obesity, alcohol consumption, tobacco use, and hepatitis B infection
DOI:
https://doi.org/10.14306/renhyd.29.4.2488Keywords:
liver cancer, tobacco, overweight, obesity, hepatitis B infection, alcohol intakeAbstract
Introduction: Liver cancer is among the most prevalent cancers globally and in Colombia. Key modifiable risk factors include overweight/obesity, excessive alcohol consumption, tobacco use, and hepatitis B virus (HBV) infection. This study aimed to estimate the potential impact of reducing exposure to these modifiable risk factors on liver cancer incidence in Colombia from 2016 to 2050. Methods: A population-based microsimulation model was implemented using the Prevent V3.1 software. The model integrates age- and sex-specific liver cancer incidence rates, latency and lag times, risk factor prevalence (with and without interventions), relative risks, and national demographic projections. Results: A 10% reduction in the prevalence of risk factors could prevent up to 728 liver cancer cases. Complete elimination of exposure could avert up to 8,648 new cases during the study period. The population attributable fractions (PAF) were 1.09% for HBV infection, 1.90% for alcohol consumption, 6.14% for tobacco use, and 14.52% for overweight/obesity. Conclusions: Reducing population-level exposure to overweight/obesity, alcohol consumption, tobacco, and HBV infection could substantially decrease the future burden of liver cancer incidence in Colombia. These projections support prioritizing risk factor reduction in national cancer prevention and public health strategies.
References
(1) Bray Bsc F, Laversanne | Mathieu, Hyuna |, Phd S, Ferlay J, Siegel Mph RL, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63, doi: 10.3322/CAAC.21834.
(2) Tan EY, Danpanichkul P, Yong JN, Yu Z, Tan DJH, Lim WH, et al. Liver cancer in 2021: Global burden of disease study. J Hepatol. 2024;0(0), doi: 10.1016/j.jhep.2024.10.031.
(3) Rumgay H, Arnold M, Ferlay J, Lesi O, Cabasag CJ, Vignat J, et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol. 2022;77(6):1598-606, doi: 10.1016/j.jhep.2022.08.021.
(4) Nevola R, Tortorella G, Rosato V, Rinaldi L, Imbriani S, Perillo P, et al. Gender Differences in the Pathogenesis and Risk Factors of Hepatocellular Carcinoma. Biology 2023, Vol 12, Page 984. 2023;12(7):984, doi: 10.3390/BIOLOGY12070984.
(5) Zhou K, Lim T, Dodge JL, Terrault NA, Wilkens LR, Setiawan VW Population-attributable risk of modifiable lifestyle factors to hepatocellular carcinoma: The multi-ethnic cohort. Aliment Pharmacol Ther. 2023;58(1):89-98, doi: 10.1111/APT.17523.
(6) Wang J, Qiu K, Zhou S, Gan Y, Jiang K, Wang D, et al. Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis. Ann Med. 2025;57(1), doi: 10.1080/07853890.2025.2455539.
(7) De Vries E, Torres MZ, Rojas MP, DÍaz G, Herrán OF Theoretical reduction of the incidence of colorectal cancer in Colombia from reduction in the population exposure to tobacco, alcohol, excess weight and sedentary lifestyle: A modelling study. BMJ Open. 2020;10(10), doi: 10.1136/bmjopen-2020-037388.
(8) Wang J, Qiu K, Zhou S, Gan Y, Jiang K, Wang D, et al. Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis. Ann Med. 2025;57(1), doi: 10.1080/07853890.2025.2455539.
(9) Rojas Hurtado MP, Herrán Falla OF, Torres Ibargüen MZ, Díaz Muñoz GA, De Vries E Variaciones hipotéticas en la incidencia y la fracción atribuible poblacional de cánceres hepático, colorrectal y de mama, como efectos de la reducción teórica del índice de masa corporal en Colombia, 2016 - 2050. Rev Fac Nac Sal Púb. 2021;39(2):14, doi: 10.17533/udea.rfnsp.e342008.
(10) Andersson TM-L, Engholm G, Pukkala E, Stenbeck M, Tryggvadottir L, Storm H, et al. Avoidable cancers in the Nordic countries—The impact of alcohol consumption. Eur J Cancer. 2018;103:299-307, doi: 10.1016/j.ejca.2018.03.027.
(11) Coppola N, Onorato L, Sagnelli C, Sagnelli E, Angelillo IF Association between anti-HBc positivity and hepatocellular carcinoma in HBsAg-negative subjects with chronic liver disease: A meta-analysis. Medicine. 2016;95(30):e4311, doi: 10.1097/MD.0000000000004311.
(12) World Cancer Research fund, American Institute for cancer research Diet, nutrition, physical activity and cancer: a global perspective. Continues Update project expert report 2015. 2015.
(13) Lee Y-CA, Cohet C, Yang Y-C, Stayner L, Hashibe M, Straif K Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer. Int J Epidemiol. 2009;38(6):1497-511, doi: 10.1093/ije/dyp280.
(14) Rui R, Lou J, Zou L, Zhong R, Wang J, Xia D, et al. Excess Body Mass Index and Risk of Liver Cancer: A Nonlinear Dose-Response Meta-Analysis of Prospective Studies. PLoS One. 2012;7(9):e44522, doi: 10.1371/journal.pone.0044522.
(15) Ott JJ, Stevens GA, Groeger J, Wiersma ST Global epidemiology of hepatitis B virus infection: New estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30(12):2212-9, doi: 10.1016/j.vaccine.2011.12.116.
(16) Ministerios de justicia y del derecho, Ministerio de salud y protección social, Observatorio de drogas de Colombia Estudio Nacional de consumo de sustancias psicoactivas en Colombia 2013. Bogota; 2014.
(17) Bienestar familiar ENSIN: Encuesta Nacional de Situación Nutricional. https://www.icbf.gov.co/bienestar/nutricion/encuesta-nacional-situacion-nutricional. [accedido 14 julio 2025]. Disponible en: https://www.icbf.gov.co/bienestar/nutricion/encuesta-nacional-situacion-nutricional.
(18) Instituto Nacional de Cancerología, Ministerio de salud y protección social Incidencia, mortalidad y prevalencia de cáncer en Colombia 2007-2011. Bogota; 2015.
(19) Comisión económica para América Latina y el Caribe Estimaciones y proyecciones: Archivos Excel. [accedido 17 febrero 2022]. Disponible en: https://www.cepal.org/es/temas/proyecciones-demograficas/estimaciones-proyecciones-excel.
(20) Nevola R, Tortorella G, Rosato V, Rinaldi L, Imbriani S, Perillo P, et al. Gender Differences in the Pathogenesis and Risk Factors of Hepatocellular Carcinoma. Biology (Basel). 2023, doi: 10.3390/biology12070984.
(21) Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, et al. AASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023;78(6):1922, doi: 10.1097/HEP.0000000000000466.
(22) Herrán OF, Bermúdez JN, del Pilar Zea M Cambios alimentarios en Colombia; resultados de dos encuestas nacionales de nutrición, 2010-2015. Rev Univ Ind Santander Salud. 2020;52(1):21-31, doi: 10.18273/revsal.v52n1-2020004.
(23) Rumgay H, Shield K, Charvat H, Ferrari P, Sornpaisarn B, Obot I, et al. Global burden of cancer in 2020 attributable to alcohol consumption: a population-based study. Lancet Oncol. 2021;22(8):1071-80, doi: 10.1016/S1470-2045(21)00279-5.
(24) Hu J, Dong H, Dong Y, Zhou R, Teixeira W, He X, et al. Cancer burden attributable to risk factors, 1990–2019: A comparative risk assessment. iScience. 2024;27(4):109430, doi: 10.1016/J.ISCI.2024.109430.
(25) Lin Y, Zheng L, Fang K, Zheng Y, Wu J, Zheng M Proportion of liver cancer cases and deaths attributable to potentially modifiable risk factors in China. Int J Epidemiol. 2023;52(6):1805-14, doi: 10.1093/IJE/DYAD100.
(26) Akter S, Rahman MM, Rouyard T, Aktar S, Nsashiyi RS, Nakamura R A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour. Nat Hum Behav. 2024;8(12):2367, doi: 10.1038/S41562-024-02002-7.
(27) Porthé V, García-Subirats I, Ariza C, Villalbí JR, Bartroli M, Júarez O, et al. Community-Based Interventions to Reduce Alcohol Consumption and Alcohol-Related Harm in Adults. J Community Health. 2021;46(3):565-76, doi: 10.1007/s10900-020-00898-6.
(28) Alrubaian F, Mulla Z Governments policy measures to address obesity among adults: a scoping review of the global evidence. Lancet. 2023;402 Suppl 1:S20, doi: 10.1016/S0140-6736(23)02132-3.
(29) Liu S, Veugelers PJ, Liu C, Ohinmaa A The Cost Effectiveness of Taxation of Sugary Foods and Beverages: A Systematic Review of Economic Evaluations. Appl Health Econ Health Policy. 2022;20(2):185-98, doi: 10.1007/s40258-021-00685-x.
(30) Lee DC, O’Brien KM, McCrabb S, Wolfenden L, Tzelepis F, Barnes C, et al. Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use. Cochrane Database of Systematic Reviews. 2024;2024(12), doi: 10.1002/14651858.CD011677.pub4.
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Copyright (c) 2020 Gustavo Díaz, Miguel Torres, Esther de Vries, Sandra Perdomo, Martha Rojas, Oscar Herran, María Paula Rugeles, Felipe Ballesteros, María Paula Belalcazar
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