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Lonardo. Metab Target Organ Damage 2024;4:7 Metabolism and
DOI: 10.20517/mtod.2023.56
Target Organ Damage

Commentary Open Access

Is liver fibrosis a risk factor for gynecological
cancers?

Amedeo Lonardo

Department of Internal Medicine, Azienda Ospedaliero-Universitaria, Modena 41126, Italy.
Correspondence to: Prof. Amedeo Lonardo, Department of Internal Medicine, Azienda Ospedaliero-Universitaria(-2023), 1135
Via Giardini, Modena 41126, Italy. E-mail: a.lonardo@libero.it

How to cite this article: Lonardo A. Is liver fibrosis a risk factor for gynecological cancers? Metab Target Organ Damage 2024;4:7.
https://dx.doi.org/10.20517/mtod.2023.56
Received: 15 Dec 2023 First Decision: 30 Jan 2024 Revised: 31 Jan 2024 Accepted: 18 Feb 2024 Published: 22 Feb 2024

Academic Editors: Natalia Rosso, Mariana Machado Copy Editor: Yanbing Bai Production Editor: Yanbing Bai

Abstract
A recent study by Crudele et al. reported on the association between surrogate indices of liver fibrosis and risk of
gynecological cancers among dysmetabolic women. To put this study in context, notions regarding sex dimorphism
in nonalcoholic fatty liver disease (NAFLD) are discussed. Additionally, meta-analytic reviews regarding the risk of
extrahepatic cancers are reviewed. Next, I discuss the relationship of metabolic dysfunction-associated fatty liver
disease (MAFLD) with extrahepatic cancers, notably including the breast and cancers of the female reproductive
systems in humans. The pathomechanisms potentially accounting for this association include genetics, deregulated
sex hormones, chronic subclinical inflammatory state, dysmetabolic milieu, oxidative stress, gut dysbiosis,
environmental pollution, and altered immune surveillance.

Keywords: Breast cancer, uterine cancer, NAFLD, MAFLD

NAFLD AND GYNECOLOGICAL CANCERS
In the 1980s, when the definitions of nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver
disease (NAFLD) were first coined , the primary concern of hepatologists was that a subset of NAFLD/
[1,2]
NASH individuals were at risk of progressing to cirrhosis. However, advancement of science has shown that
the majority of (non-cirrhotic) NAFLD patients die from liver-unrelated causes, i.e., cardiovascular and
extrahepatic cancers . While the former outcome may be predicted owing to the strong association
[3]

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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