Study on the changing global burden of liver cancer in the 21st century: more cases, new causes

In short: Many more people worldwide are diagnosed with and die from liver cancer than in 2000: in 2023 there were 578,132 new cases and 507,716 deaths. Per 100,000 people, rates have fallen since 2000 but have been rising again since about 2020. Viral hepatitis remains the most common cause, though its share is shrinking. Liver cancer linked to fatty liver (MASLD) is growing fastest ¹.

Status of the evidence: This is a study with its own analyses of existing large databases (Global Burden of Disease 2023 and the WHO mortality database), not a systematic review. Data cover 2000 to 2023 (causes of death by country and cancer type up to 2021). Published online on 2 July 2026, in print in October 2026 in the Journal of Hepatology (volume 85, issue 4). Article written on 6 October 2026. Newer data are not covered.

What is this about?

The subject is primary liver cancer, mostly hepatocellular carcinoma (HCC) and less often intrahepatic cholangiocarcinoma (iCCA, a bile duct cancer inside the liver). It is the third most common cause of cancer death worldwide and very dangerous: deaths are almost as numerous as new cases. The study asks how frequency and causes have changed since 2000.

What does the study show?

New cases rose from 362,689 (2000) to 578,132 (2023), an increase of 59.4%. Deaths rose from 325,809 to 507,716 (up 55.8%). At the same time, age-standardised rates, which remove the effect of population growth and ageing, fell from 7.05 to 6.37 new cases per 100,000 people. The rise in case numbers is therefore mainly due to more and older people. Since about 2020, however, age-standardised rates have also been rising again.

Which causes play a role?

In 2023, 37.9% of cases were due to hepatitis B, 29.6% to hepatitis C, 18.7% to alcohol and 7.9% to fatty liver (MASLD). The share of viral hepatitis fell from 71.9% to 67.5%. Liver cancer linked to fatty liver grew fastest, by 3.2% per year. Since 2020, rates linked to hepatitis B and C have also risen again after years of decline. Causes differ strongly by region: hepatitis B dominates in East Asia and Sub-Saharan Africa, hepatitis C in the Middle East, North Africa and the Americas, and alcohol in Europe and Australia/New Zealand. The highest rate was in Mongolia (67.84 per 100,000).

And bile duct cancers?

For intrahepatic bile duct cancers (iCCA), death rates rose in most countries; only Greece, Japan and Singapore saw declines. The authors call for dedicated research on bile duct cancer.

Where are the limits?

The database does not distinguish between HCC and iCCA. Data quality and diagnosis coding vary by region, and some trends may reflect changes in diagnosis and reporting. Why rates have been rising again since 2020 is unclear: possible explanations include effects of the COVID-19 pandemic (cancers found late) or more cancer registries in the new data version. Rare causes such as haemochromatosis were not available. The authors received no study-specific funding; some report ties to pharmaceutical companies (e.g. Gilead, AstraZeneca, Novo Nordisk, Madrigal).

What does this mean for me?

Most liver cancers arise from recognisable and treatable liver diseases. Hepatitis B vaccination, treatment of hepatitis B and C, less alcohol and a healthy weight lower the risk. If you have hepatitis, cirrhosis, fatty liver with scarring or hazardous alcohol use, talk to your doctor about check-ups. Which examinations make sense is decided by your doctor.

This article does not replace medical advice.