Natalie Day
CEO, the Foundation for Liver Research
Dr Shilpa Chokshi
Chief Scientific Officer, the Institute of Hepatology, London
Liver cancer is often described as a silent killer, with few overt symptoms and diagnosis often only once the illness is at a relatively advanced stage, by which time there are fewer treatment options.
There are around 6,100 new liver cancer cases in the UK every year, that’s 17 every day. There are around 5,600 liver cancer deaths every year, that’s 15 every day.
Since the early 1990s, incidence rates in the UK have increased by 166%. Cancer Research UK projects that by 2035, the annual total will be 11,133 cases of liver cancer (7,770 in males, 3,364 in females). Sadly, just 13% of patients diagnosed with liver cancer survive for five or more years.
In the UK, 20% of liver cancer cases are caused by smoking; 23% by overweight and obesity; and 7% of cases caused by alcohol.
A disease of inequalities
Incidence rates in England in women are 78% higher in the most deprived quintile of the population compared with the least and 89% higher for men. Around 1,200 cases of liver cancer each year in England are linked with deprivation (around 390 in women and 810 in men). In the UK, 20% of liver cancer cases are caused by smoking; 23% by overweight and obesity; and 7% of cases caused by alcohol.
Access to specialist care
There is a further inequality, access to specialist care. In 2013, the Royal College of Physicians estimated that the equivalent of one full time gastroenterology/hepatology consultant was needed per 41,667 of population.
A 2018 survey by the British Society of Gastroenterology (BSG) showed this is achieved in London (not South London) and the Northern sub-region but in the Thames Valley and Wessex there are more than 60,000 people per consultant. Scotland, Northern Ireland and Wales also fail to meet the RCP estimate with one consultant per more than 70,000 population. In Scotland, the variation is from 48,726 in the South to 70,820 population in the West.
The quiet epidemic
The NHS faces many challenges and in the last year we have seen it stretched to the limit, with its staff showing astonishing levels of dedication and care for their patients. Quite rightly, there will now be a major process of review and planning for the future. But there is another quiet epidemic already underway for which the NHS is poorly prepared.
Cancer Research UK: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/liver-cancer#heading-Four accessed 7/3/2021
Consultant Physicians Working with Patients: The duties, responsibilities and practice of physicians in medicine. Revised 5th edition 2013.
file:///C:/Users/k1508281/Downloads/Consultant%20physicians%20working%20with%20patients%20-%20revised%205th%20edition.pdf accessed 7/3/2021
British Society of Gastroenterology Workforce Report Dr Charlotte Rutter – October 2019 https://www.bsg.org.uk/wp-content/uploads/2020/02/British-Society-of-Gastroenterology-Workforce-Report-2019-.pdf accessed 7/3/2021
