Lancet Commission 2025 Calls for Urgent Global Action: 60% of Liver Cancers Are Preventable.

Introduction
A new report by the 2025 Lancet Commission has delivered a bold and urgent message to the global health community: three in five liver cancer cases could be prevented with existing tools and strategies (co-first authors: Stephen Lam Chan, Hui-Chuan Sun, Yang Xu, Hongmei Zeng, Commission Chairs and co-corresponding authors: Masatoshi Kudo, Jia Fan, Jian Zhou) [1]. At a time when liver cancer is projected to kill 1.37 million people annually by 2050, the Commission’s findings serve both as a wake-up call and a roadmap for action. The 2025 Commission brings together over 60 global experts in oncology, hepatology, epidemiology, and public health (Table 1), offering a comprehensive analysis of hepatocellular carcinoma (HCC) and laying out a blueprint for reversing the projected surge in cases.

The Scale of the Problem
Liver cancer is now the sixth most common cancer globally and the third leading cause of cancer-related death [2]. Without significant changes, the number of new liver cancer cases will increase from 870,000 in 2022 to 1.52 million by 2050. This dramatic growth is driven by demographic changes like aging populations and increasing rates of metabolic disease.
Hepatocellular carcinoma accounts for around 80% of all primary liver cancers. The disease is notoriously known for high recurrence rate and difficult to treat, with 5-year survival rates ranging from 5% to 30% [3], depending on region and access to care. Most cases are diagnosed late, limiting treatment options [4].

The “Three in Five” Prevention Prediction
The central figure from the Lancet Commission is stark: at least 60% of liver cancer cases are preventable. The Commission’s prediction is based on epidemiological modeling that shows that a 2–5% annual reduction in age-standardized incidence rates (ASIR) could prevent 8.8 to 17.3 million new cases and save 7.7 to 15.1 million lives globally by 2050. To achieve this, public health systems must move beyond a treatment-focused approach and instead prioritize risk factor mitigation, early detection, and widespread screening.

Key Preventable Risk Factors

Hepatitis B and Hepatitis C
Hepatitis B (HBV) and hepatitis C (HCV) are responsible for the majority of HCC cases. In 2022, HBV accounted for 39% and HCV for 29.1% of all liver cancers. Though these proportions are expected to decline slightly by 2050, HBV will remain the leading cause.
Effective interventions include HBV vaccination, antiviral therapy, and universal screening. Yet gaps remain, particularly in low-income countries where vaccination access is limited, and stigma or lack of awareness deters individuals from seeking testing.

Alcohol Use
Alcohol-related liver cancer is expected to rise from 18.8% of cases in 2022 to 21.1% by 2050. Excessive alcohol consumption leads to cirrhosis and cellular damage, increasing cancer risk. The Commission supports alcohol taxation, advertising restrictions, and minimum unit pricing as proven policy levers.

MASLD and MASH (Metabolic Liver Disease)
Formerly known as NAFLD, metabolic dysfunction-associated steatotic liver disease (MASLD) is an umbrella term for liver diseases associated with obesity, diabetes, and sedentary lifestyles. Its more severe form, MASH (steatohepatitis), is rapidly becoming a leading driver of liver cancer, especially in the USA, Europe, and East Asia [5].
The Commission projects that MASH-related liver cancers will increase from 8% of total cases in 2022 to 10.8% by 2050, unless urgent action is taken. Prevention here includes public health policies to combat obesity, improve diet, and promote physical activity.

Environmental Risk Factors
Exposure to aflatoxins, or polluted water, particularly in sub-Saharan Africa and parts of Asia [6] and fine particulate matter (PM 2.5) [7] also plays a significant role in hepatocarcinogenesis. Improving food storage, air quality, and access to clean water is essential.

MASLD: The Hidden Epidemic
MASLD is now estimated to affect one in three adults globally, yet public awareness is extremely low. It often progresses silently and can lead to cirrhosis and cancer without any symptoms. Even patients who do not develop full-blown MASH face increased risks of cardiovascular disease, diabetes, and early mortality.
The Lancet report identifies MASLD as a ticking time bomb for cancer incidence. The condition is closely tied to modern diets rich in sugar and fat, and a lack of physical activity. The report advocates for sugar taxes, food labeling laws, and improved urban planning to enable healthier lifestyles.

A Role for New Therapies: Could GLP-1s Help?
The report also notes potential secondary benefits from the rising use of GLP-1 receptor agonists (e.g., semaglutide, tirzepatide), originally developed for diabetes and obesity. These drugs have been shown to reduce liver fat and inflammation, potentially halting MASLD progression [8–10]. While not yet approved specifically for liver cancer prevention, their impact could be substantial, particularly in countries with high obesity rates.

From Late-Stage Treatment to Early Intervention
One of the most actionable findings in the report is the need to scale up early detection and screening. Surveillance programmes using ultrasound and AFP (alpha-fetoprotein) testing are proven to catch liver cancer at earlier, more treatable stages. Yet in most countries, less than 25% of eligible individuals undergo regular screening.
Barriers include low public awareness, logistical challenges, and a lack of national policy mandates. The Commission recommends integrating liver cancer surveillance into primary care, especially for those with cirrhosis, viral hepatitis, or metabolic risk factors.

The Japan Model
In the Lancet Commission, Japan’s efforts were highlighted as a “world-leading model” of HCC control [11–14]. Since the 1980s, Japan has implemented nationwide surveillance programs targeting individuals with HBV/HCV infection and cirrhosis. As a result of these efforts, 68% of HCC cases were detected as solitary tumors, and 53% were identified at a diameter of ≤3 cm [11, 12]. To facilitate the detection of asymptomatic virus carriers, free viral testing was introduced, and hepatitis screening was incorporated into annual health check-ups, thereby establishing a comprehensive screening system. The policy and insurance framework further reinforced surveillance by covering AFP, AFP-L3, and PIVKA-II testing [15, 16], together with imaging modalities such as ultrasound, CT, and MRI, under the national insurance scheme.
In addition, antiviral therapy was promoted through special government programs, which accelerated the adoption of direct-acting antivirals (DAAs) and nucleos(t)ide analogs. Recognizing the burden of non-viral HCC, national policies also incorporated interventions such as nutrition counseling, exercise promotion, and diabetes management to address MASLD/MASH. These measures were supported by multi-stakeholder collaboration, involving the Japan Society of Hepatology, the Japan Association of Liver Cancer (Formerly, Liver Cancer Study Group of Japan), government agencies, such as Japan Ministry of Health, Labour and Welfare (MHLW) and liver disease patient advocacy organizations, which worked together to advance evidence-based strategies. The Japan Society of Hepatology plays a vital role in promoting public awareness of liver cancer risks and providing education to liver disease patients and private practitioners [16]. Through these comprehensive interventions, Japan has successfully reduced both the incidence and mortality of HCC, becoming the first country to demonstrate, on a national scale, the preventability of this disease [1, 17].

Regional Inequities
Despite the availability of preventive tools, access remains highly uneven across regions. For instance, HBV vaccination rates are still critically low in parts of Africa and South-East Asia, and access to antiviral treatments is limited by cost.
Meanwhile, high-income countries face rising rates of MASLD and alcohol use, but often lack comprehensive prevention programmes. These dual challenges require region-specific responses, coordinated through global health partnerships and WHO leadership.

Roadmap in Liver Cancer Control in Asia
The Asia-Pacific region is both the epicenter and the solution. The roadmap on liver cancer control noted the following situation in Asia [17].
Challenges include late-stage diagnosis (80% advanced), uneven access to diagnostics, and surging MASLD. In China, liver cancer remains a major health burden. While the widespread implementation of HBV vaccination has led to improvements, the rise of metabolic-related HCC has become increasingly prominent. In Korea, strong screening and surveillance systems are well established, but the growing elderly population poses a renewed challenge to the overall burden. In Vietnam, HBV continues to be the dominant cause, yet limited resources hinder effective surveillance efforts. In India, the burden from alcohol-related liver disease and MASLD is rising, and the absence of a comprehensive national strategy remains a significant concern.
The roadmap organizes interventions along the patient journey: public awareness, prevention, detection, diagnosis, treatment. Public campaigns, subsidized testing, equitable access to ultrasound, and treatment reimbursement are emphasized [17].
Japan’s model is cited as a benchmark, particularly its integration into insurance and high early detection rates [13]. Regional collaboration such as registries, trials, educations and training will accelerate progress.

Policy Recommendations
The Lancet Commission offers ten key recommendations to reduce liver cancer burden:1.Strengthening viral hepatitis prevention, screening, and treatment

2.Reduction of alcohol consumption.

3.Control of environmental risk factors.

4.Preparing for the increase in MASLD and MASH.

5.Raising awareness of liver health.

6.Improving early HCC detection.

7.Standardization of non-invasive diagnosis of HCC.

8.Addressing the East-West differences in clinical management.

9.Improving HCC survivorship.

10.Facilitating access to treatment.

Conclusions
Liver cancer may be one of the few major cancers where the path to prevention is clear and achievable. From vaccines and antiviral therapies to sugar taxes and early screening, the tools exist. What’s needed now is political will, cross-sector collaboration, and public engagement.
As the Lancet Commission concludes, “Liver cancer is largely preventable, yet continues to kill millions. Prevention must no longer be an afterthought: it must be the foundation of our global response.” (Fig. 1).

Statement of Ethics
A statement of ethics is not needed because this study was based exclusively on published data.

Conflict of Interest Statement
Lectures: Chugai, Eisai, and AstraZeneca. Grants: Otsuka, Taiho, and Chugai, GE Healthcare, Eisai, Advisory Consulting: Chugai, Roche, Eisai, AstraZeneca. Masatoshi Kudo is the Editor-in-Chief of Liver Cancer.

Funding Sources
There was no funding for this editorial.

Author Contributions
Masatoshi Kudo conceived, wrote, and approved the final manuscript.