Advancing policy and practice in alcohol-associated liver disease and alcohol-attributable cancer: Correspondence to the editorial on “Sex disparities in alcohol-associated liver disease and subtype differences in alcohol-attributable cancers in the United States” (original) (raw)

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Correspondence

Clinical and Molecular Hepatology 2026;32(1):e96-e98.
Published online: May 15, 2025

1Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

2Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA

3Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA

4Department of Internal Medicine, Banner University Medical Center, Phoenix, AZ, USA

5BIO5 Institute, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA

6Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

7Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA

Corresponding author : Pojsakorn Danpanichkul Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA E-mail: pojsakorndan@gmail.com

Ju Dong Yang Medical Director of Liver Cancer Program, Associate Professor of Medicine, Karsh Division of Gastroenterology and Hepatology, Comprehensive Transplant Center, and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8900 Beverly Blvd, Los Angeles, CA 90048, USA Tel: +1-310-423-1971, Fax: +1-310-423-2356, E-mail: judong.yang@cshs.org

• Received: May 13, 2025 • Accepted: May 14, 2025

Copyright © 2026 by The Korean Association for the Study of the Liver

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Full Article

Dear Editor,

We sincerely appreciate Dr. Kim’s thoughtful commentary on our recent publication, “Sex disparities in alcohol-associated liver disease and subtype differences in alcohol-attributable cancers in the United States” [1,2]. The editorial effectively underscores the pressing need to address the increasing burden of alcohol-associated liver disease (ALD) and alcohol-attributable cancer.

Indeed, the global toll of alcohol misuse is staggering, contributing to millions of deaths annually. While prior studies had emphasized the rising incidence of alcohol use disorder (AUD) in females [3], our study added to this literature by showing that ALD is also disproportionately [1]. The GBD 2021 estimates mark the first time in the GBD cycle that trends could be evaluated, including during the coronavirus disease 2019 (COVID-19) pandemic period [1,4]. The COVID-19 pandemic significantly disrupted routine healthcare services, leading to delays in detecting and managing chronic conditions, including ALD. According to data from the National Vital Statistics System database, ALD-related mortality in the U.S. rose sharply during the early phase of the COVID-19 pandemic [5]. This sharp rise during the early phase of the pandemic was noted across all racial and ethnic groups except non-Hispanic Asian individuals and both sexes [6]. Moreover, data from the latest National Health and Nutrition Examination Survey showed that the prevalence of advanced fibrosis in SLD was significantly higher during the COVID-19 pandemic [7]. This increase was likely exacerbated by heightened alcohol consumption during this period, further compromising liver health in the U.S. population. The disproportionate increase in ALD among females found in our study is concerning, as females are more biologically vulnerable to the effects of alcohol than males [3]. These changes have implications beyond liver disease, as alcohol is a known carcinogen implicated in liver, breast, and aerodigestive tract cancers [8,9].

Addressing these intertwined problems requires targeted research into systemic barriers that hinder care access, along with strengthening alcohol-related policy. A prior ecological study showed that a significant drop in ALD mortality occurred four years after policy establishment, and liver cancer-related improvements emerged at 7–8 years, reinforcing a crucial message: public health policies may not yield immediate dividends but can reshape population health over time [10]. Tackling this crisis requires a comprehensive approach at multiple levels. At the individual level, clinicians can screen for alcohol use and facilitate referrals to behavioral therapy, addiction medicine, and social services [11]. Embedding social workers or patient navigators within liver and cancer clinics may help address barriers to care and promote adherence. At the community level, public education campaigns that target stigma and raise awareness about the carcinogenic risks of alcohol can promote informed decision-making [12]. At the policy level, interventions such as taxation, reduced hours of alcohol sales, and restricting marketing have demonstrated impact. Success will require coordinated efforts across stakeholders which is essential to promote alcohol cessation, early detection, timely intervention, and widespread awareness of alcohol-related harm, including ALD and alcohol-attributable cancer [13,14]. Moreover, efforts to reduce concomitant risk factors of SLD, such as metabolic risk factors, need to be executed [4,15].

Collectively, these efforts represent a necessary shift from passive recognition of epidemiologic trends to proactive, sustained intervention. By integrating clinical, community, and policy strategies, we can meaningfully reduce the burden of ALD and alcohol-attributable cancers and promote population health.

FOOTNOTES

Authors’ contribution

Writing, original draft – Pojsakorn Danpanichkul, Karn Wijarnpreecha. Writing, review, and editing – Donghee Kim, Ju Dong Yang, Amit G. Singal. All authors have read and approved the final version of the manuscript for submission.

Conflicts of Interest

Amit G. Singal has served as a consultant or on advisory boards for Fujifilm Medical Sciences, Exact Sciences, Glycotest, Roche, Abbott, DELFI, GRAIL, Genentech, AstraZeneca, Eisai, Bayer, Exelixis, Merck, Elevar, Boston Scientific, Sirtex, and HistoSonics. Ju Dong Yang consults for AstraZeneca, Eisai, Exact Sciences, and FujiFilm Medical Sciences.

Abbreviations

ALD

alcohol-associated liver disease

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Advancing policy and practice in alcohol-associated liver disease and alcohol-attributable cancer: Correspondence to the editorial on “Sex disparities in alcohol-associated liver disease and subtype differences in alcohol-attributable cancers in the United States”

Clin Mol Hepatol. 2026;32(1):e96-e98. Published online May 15, 2025

Advancing policy and practice in alcohol-associated liver disease and alcohol-attributable cancer: Correspondence to the editorial on “Sex disparities in alcohol-associated liver disease and subtype differences in alcohol-attributable cancers in the United States”

Advancing policy and practice in alcohol-associated liver disease and alcohol-attributable cancer: Correspondence to the editorial on “Sex disparities in alcohol-associated liver disease and subtype differences in alcohol-attributable cancers in the United States”