Implementing genetic screening for the management of hepatic disease

Liver cirrhosis is an advanced stage of liver fibrosis causing liver failure, and may progress to hepatocellular carcinoma (HCC). HCC remains as the second leading cause of cancer-related deaths worldwide and is one of few cancer types to show increasing incidence and mortality rates (1). HCC incidence has doubled in low-risk countries such as USA, Canada, Australia, and some European countries since the 1970s (2) and mortality rates have increased in these regions, especially in 45+ age groups (3). This may be attributed to intravenous drug use in this cohort associated with high HCV infection rates between 1960–1980 (4). Additionally, an increasing amount of HCC cases are non-viral (5). Thus, the rise in HCC deaths in Westernized countries may be attributed to increased obesity and diabetes prevalence, both well-established risk factors for non-alcoholic fatty liver disease (NAFLD), non-alcoholic hepatic steatosis (NASH), and progression to HCC. Regardless of original cause, 85–90% of HCC cases arise from underlying cirrhosis and non-cirrhotic cases show varying stages of fibrosis. Unfortunately, progression of hepatic fibrosis to cirrhosis is often asymptomatic and most diagnoses are not made until clinical signs arise indicating end-stage liver disease (ESLD) or advanced HCC (6). Thus, a relevant strategy of reducing liver disease-related deaths are to take preventative measures and improve disease management.