Volume 215 - Issue 7
Australian recommendations for the management of hepatocellular carcinoma
Author: Alain Braillon
Med J Aust 2021; 215 (7): 334-334.e1. || doi: 10.5694/mja2.51259
Published online: 4 October 2021
Published online: 4 October 2021
To the Editor: I read with interest the consensus statement on hepatocellular carcinoma (HCC)1 and wonder why it overlooked that smoking is a major cause.
Smoking is an independent and dose‐related contributing factor for HCC (relative risk, 1.51; 95% CI, 1.37–1.67) around the world.2,3 In a large European cohort, the population‐attributable fraction — the proportional reduction in population disease or mortality that would occur if exposure to a risk factor were reduced to an alternative ideal exposure scenario — for tobacco use in HCC was 48 %, more than twice the population‐attributable fraction of the second most common risk factor: hepatitis C (21%).4 In France, where smoking prevalence is high and roughly twice that in Australia, tobacco, viral hepatitis and alcohol contribute to 33%, 31% and 26% respectively of HCC cases.5
The issue is not only about prevention but also about care, as smoking cessation is an important factor in cancer outcomes (ie, treatment effectiveness, overall survival, risk of second primary malignancies, and quality of life).
Lastly, only nine out of 31 recommendations in the consensus statement are graded “A1” and none are among the four related to surveillance.
Competing interests
No relevant disclosures.
References
- Lubel JS, Roberts SK, Strasser SI, et al. Australian recommendations for the management of hepatocellular carcinoma: a consensus statement. Med J Aust 2021; 214: 475–483. https://www.mja.com.au/journal/2021/214/10/australian-recommendations-management-hepatocellular-carcinoma-consensus
- Lee YC, Cohet C, Yang YC, et al. Meta‐analysis of epidemiologic studies on cigarette smoking and liver cancer. Int J Epidemiol 2009; 38: 1497–1511.
- Jee SH, Ohrr H, Sull JW, Samet JM. Cigarette smoking, alcohol drinking, hepatitis B, and risk for hepatocellular carcinoma in Korea. J Natl Cancer Inst 2004; 96: 1851–1856.
- Trichopolous D, Bamia C, Lagiou P, et al. Hepatocellular carcinoma risk factors and disease burden in a European cohort: a nested case‐control study. J Natl Cancer Inst 2011; 103: 1686–1695.
- Hill C, Doyon F, Mousannif A. Évolution de la mortalité par cancer en France de 1950 à 2006 [Evolution of cancer mortality in France from 1950 to 2006]. Institut de Veille Sanitaire, 2009. https://www.santepubliquefrance.fr/docs/evolution-de-la-mortalite-par-cancer-en-france-de-1950-a-2006 (viewed Jan 2020).