Potential impact of controlling risk factors on future liver cancer deaths in China

Objective: This study aims to quantify the potential impact of controlling major risk factors on liver cancer deaths in China from 2021 to 2050 under various intervention scenarios. Methods: We developed a macro-level simulation model based on comparative risk assessment to estimate population attributable fractions and avoidable liver cancer deaths. Risk factor prevalence data were obtained from national surveys and epidemiological estimates. Three intervention scenarios for each risk factor were projected: elimination (Scenario 1), ambitious reduction (Scenario 2), and manageable targets aligned with national/global goals (Scenario 3). The impact of secondary prevention through liver cancer screening at different coverage was evaluated. Results: Between 2021 and 2050, liver cancer deaths in China are projected to reach 9.44 million in males and 4.29 million in females. Eliminating hepatitis B virus and hepatitis C virus could prevent 65.62% (57.47%-73.77%) and 28.47% (24.93%-32.00%) of liver cancer deaths, respectively. Achieving manageable targets in reducing the prevalence of smoking and alcohol drinking could prevent 6.57% (5.75%-7.38%) and 0.85% (0.75%-0.96%) of liver cancer deaths, with a more pronounced effect observed in males. Eliminating high body mass index (BMI) could avert 45,000 male and 25,000 female deaths annually by 2050, while diabetes elimination could prevent 60,000 male and 21,000 female deaths. Secondary prevention through liver cancer screening with 80% coverage could reduce liver cancer deaths by 3.59% (3.14%-4.04%) for the total population. Combining all interventions under Scenario 1 could prevent up to 88.39% (76.65%-99.81%) of male and 77.80% (67.42%-87.88%) of female liver cancer deaths by 2050. Conclusions: Comprehensive risk factor control could prevent over 80% of liver cancer deaths in China by 2050. Secondary prevention through screening may offer modest additional benefits. These findings provide strong quantitative support for targeted, evidence-based interventions and underscore the need for policy action to address key risk factors.