“In Italy, liver tumors are around 12,000 a year in this historical phase, which means a relatively low incidence. However, if we take into consideration patients suffering from advanced chronic liver disease, i.e. with cirrhosis, then the incidence also reaches 2-3% per year, which means that if a doctor follows 100 cirrhotics he must expect that every year three of these will develop cancer and it is a high percentage”. Thus Fabio Farinati, director of Gastroenterology of the Aou of Padua and director of the Department of Surgical, Oncological and Gastroenterological Sciences, on the occasion of the conference ‘Screening strategies and prevention of digestive tumors: the European Project’, promoted in Rome by the Foundation for digestive diseases (Fmd) to illustrate the European recommendations and the useful actions to be implemented in Italy so that a healthier lifestyle is promoted and prevention programs are encouraged.
“The historical risk factors are those from the hepatitis B virus – he explains to Adnkronos Salute – which is constant over time despite the vaccination; hepatitis C infection, which is instead drastically decreasing following treatments with drugs that eradicate the infection; alcohol, which in this phase is responsible for 20-30% of liver tumors and which sees an excess of consumption in the young population” which could be “dangerous in the future”. Finally “there is the big problem of the metabolic syndrome, that is, all those alterations of metabolism such as obesity, diabetes, hypertension and overweight, which cause an accumulation of fat in the liver with an inflammation of the same which can lead to the development of cancer”.
According to the expert, it would be necessary to “flush out all the subjects who do not yet know they are affected and here there is also a screening of the infection to be carried out. Then educational campaigns should be carried out for young people, both as regards alcohol consumption as regards an adequate lifestyle, therefore a Mediterranean diet and adequate physical activity that avoids the metabolic syndrome. And then the surveillance of subjects suffering from chronic liver disease”.
One chapter is about the need to have adequate biomarkers. “Unfortunately – Farinati points out – at present neither from standard medicine nor from molecular biology we have come into possession of a marker with high sensitivity and specificity. Alpha-fetoprotein is traditionally used, but this does not diagnose about 50% of affected patients , therefore it has very important false negatives. The association of alpha-fetoprotein and ultrasound is what many do and which increases our diagnostic penetrance, but it is certainly not yet optimal”.
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