Liver cancer is one of the commonest cancers worldwide but with a very different pattern of distribution to lung and breast cancer. It is of particular interest as a freely available vaccination (against hepatitis B) can effectively prevent the development of cancer. Overall, it is the sixth most common cancer in terms of new cases, but the third most common cause of cancer death, reflecting the highly aggressive nature of the disease. There are a number of key features to the pattern of cases of liver cancer that merit more detailed examination. It is between 5 and 7 times more common in parts of China and Africa than in Europe and North America. The disease is almost always lethal, partly because it occurs in parts of the world with less developed healthcare, but mostly because it arises as a result of serious damage to the liver by the hepatitis B virus.
Liver cancer is linked to chronic liver damage, and in Europe and North America, this is generally caused by alcohol abuse. In the parts of the world where the cancer is more common, the more important factor is infection with the hepatitis B virus (HBV), first described in 1965 by Dr Baruch Blumberg, who received the Nobel Prize for his work. Epidemiological studies established the link between hepatitis and liver cancer some years ago. Subsequent work showed that the molecular biology of the virus was consistent with it having a direct causative role rather than this being a chance association. With the linkage between virus and cancer established, the possibility of a vaccine against common cancer became a reality. Pleasingly for all concerned, HBV vaccination has been a great success, with benefits appearing in the highest-risk populations very rapidly.