Impact of Egypt’s Hepatitis C Elimination Program on Liver Cancer Burden with Projections to 2050

Introduction: Primary liver cancer remains a leading cause of cancer-related mortality worldwide, with Egypt representing a uniquely high-burden setting due to historically widespread hepatitis C virus infection. This study aimed to comprehensively evaluate long-term trends in the burden of Primary liver cancer in Egypt from 1990 to 2023, with particular emphasize on the impact of the national HCV elimination campaign, and project future trends through 2050. Methods: Data were obtained from the Global Burden of Disease 2023 database. Age-standardized incidence, mortality, prevalence, and disability-adjusted life years (DALYs) for Primary liver cancer were analyzed by sex and underlying etiology. Future projections to 2050 were generated using the GBD forecasting framework. Results: Between 1990 and 2023, age-standardized incidence, mortality, and DALY rates for PLC in Egypt declined overall, with the steepest reductions observed between 2014 and 2019, coinciding with nationwide HCV eradication efforts. However, a rebound in incidence and mortality was observed after 2019. HCV remained the leading cause of Primary liver cancer mortality throughout the study period, although its contribution declined substantially. Notably, nonalcoholic steatohepatitis surpassed hepatitis B as the second leading cause of Primary liver cancer mortality by 2023. Projections suggest that comprehensive control of viral and metabolic risk factors could reduce Primary liver cancer mortality by nearly half by 2050. Conclusion: Egypt’s HCV elimination campaign substantially reduced the burden of Primary liver cancer; however, long-term surveillance and integrated, multi-etiologic prevention strategies are essential to achieve durable reductions in Primary liver cancer burden.