Mainstream Liver Cancer Screening As Malaysians Gain Weight: Experts

Metabolic associated fatty liver disease, linked to obesity and diabetes, is a risk factor for liver cancer.

KUALA LUMPUR, April 30 — Experts have called for expanded screening in the general population to curb liver cancer, the eighth most common cancer in Malaysia, amid rising obesity and diabetes.

According to Globocan 2020, last year, 2,149 new liver cancer cases were reported across both sexes, comprising 4.4 per cent of types of cancers reported.

Ministry of Health (MOH) deputy director of non-communicable diseases (NCD) Dr Feisul Idzwan Mustapha and Dr Nor Saleha Ibrahim Tamin from MOH’s cancer prevention and control programme pointed out that currently, screening for liver cancer is only done among high-risk groups.

“For example, those diagnosed with Hepatitis B positive will be monitored and screened, not a population-based or opportunistic screening,” Dr Feisul and Dr Nor Saleha told CodeBlue in a joint response.

However, Hepatitis B and C are not the only risk factors that can cause liver cancer. The two experts highlighted that metabolic associated fatty liver disease (MAFLD) is also a major risk factor for liver cancer.

“Non-alcoholic fatty liver disease (NAFLD), or now the recently adopted term ‘metabolic associated fatty liver disease’ (MAFLD), is increasing rapidly, being closely associated with the increasing prevalence of obesity and diabetes,” Dr Feisul and Dr Nor Saleha said.

“Specifically for MAFLD, incorporating screening and managing MAFLD into existing NCD-related programmes and activities would be a logical step (rather than a siloed approach).”

MAFLD is associated with globesity (global obesity), in which the body mass index of the individual is more than 30kg/m2. MAFLD occurs as fat accumulates in the liver cells.

The 2019 National Health and Morbidity Survey showed that one in two adults in Malaysia are either overweight or obese, while half have abdominal obesity.

Dr Chieng Jin Yu, a consultant physician, gastroenterologist, and hepatologist from Pantai Hospital, Ampang, said that chronic infection with Hepatitis B or C virus is the most common risk factor for liver cancer.

Besides Hepatitis B and Hepatitis C infection, liver cirrhosis (loss and irreversible damage of liver cells) is also a risk factor for liver cancer.

“The annual risk of developing hepatocellular carcinoma among patients with cirrhosis is between two per cent and five per cent and appears to be a cumulative risk,” Dr Chieng told CodeBlue.

The hepatologist suggested more stringent Hepatitis B antigen screening for high-risk groups, including undocumented immigrants. As the Hepatitis B virus spreads through infected blood and body fluids, it is commonly seen among drug abusers who often share needles.

Dr Chieng also said that the frequency of liver screening should be increased among the elderly and high-risk populations.

“Screening programmes should consist of lifelong, six monthly abdominal ultrasound scans, and biomarker alpha fetoprotein testing. Patients with poor quality ultrasonographic images can be further evaluated with multiphase contrast enhanced CT or MRI.”

Besides that, he highlighted that once diagnosed with liver cancer, patients still have to endure other forms of burden while also dealing with their health condition.

“Many patients face financial problems in treatment of liver cancer,” Dr Chieng added.

“They usually need to wait in a long queue to see a hepatologist or hepatobiliary surgeon due to the lack of facilities and manpower in government hospitals.”

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