About the Research Project

The EVALUATE (the development of MASLD among survivors of breast and colorectal cancer) research project is investigating liver health in people who have had breast or colorectal cancer in the past (between 5 and 10 years ago). Specifically, we are focusing on a liver disease called fibrotic MASLD – Metabolic Dysfunction-Associated Steatotic Liver Disease, formerly known as non-alcoholic fatty liver disease (NAFLD). 

Put simply, our project is called EVALUATE: Liver Health in Breast and Colorectal Cancer Survivors.

What is a metabolic dysfunction?

A metabolic dysfunction is a condition where your body has problems with converting food into energy, using energy or storing energy properly. Examples of metabolic diseases include obesity, diabetes, and high blood pressure.

What is metabolic-associated steatotic liver disease (MASLD)?

MASLD is a condition where fat builds up in the liver due to metabolic issues. Excess liver fat can cause inflammation and scaring (known as fibrosis) which can lead to liver failure. 

MASLD can have different severities. Non-fibrotic MASLD is when there is a small amount of fat in the liver and usually does not cause major problems. However, it can get worse over time and can develop into fibrotic MASLD. 

We recommend the following video for more information on MASLD. Subtitles can be used to help you understand it better and can be translated into German, French or Italian.

Link to the video

What is fibrotic MASLD?

Fibrotic MASLD is where there is more and more scaring in your liver. Scaring can destroy your working liver cells and are replaced by thickening which cannot do the liver’s detoxifying job. This can lead to liver failure if there is too much the scaring of the liver.

Early diagnosis is important since liver damage could be reversed with lifestyle changes, diet and new medications.

Who is affected by MASLD?

MASLD is very common; about 1/3 of the world’s population is affected. In Switzerland, it is predicted that 1/4 of the population may be affected. MASLD can affect anyone who has any metabolic issues. 

We are interested in seeing if it is more common in people who had cancer in the past, either because there is some shared cause or interaction, or whether some cancer treatments could play a role in MASLD development.
 

Why is it important to study MASLD?

Studying MASLD is important because it is very common. Learning more about it can help people and researchers find better ways to prevent and manage it at an early stage so it does not progress. It is also important as new treatments are now available that seem effective in stopping and reversing the liver damage.

Furthermore, it is important to find out who would be more likely to develop MASLD, that is whether people who had cancer have a higher risk. If this was the case, it could be part of follow up care, and we could then study whether it would be helpful to do regular testing to diagnose it early and start treatment before it is worsening.

How can MASLD be diagnosed?

Currently, liver biopsy is the standard method of diagnosing MASLD, as it provides the most accurate results. However, liver biopsy is uncomfortable and carries small but real risks like pain and infections.

Newer non-invasive technologies, such as a test very similar to a normal ultrasound, known as ultrasound-based vibration-controlled transient elastography (VCTE; also called after the machine “FibroScan®”) might be able to replace liver biopsy, due to advances in technology. They may be safer and quicker, but we need to understand how accurate they are. This may also be true for liver Magnetic Resonance Imaging (MRI).

What is the connection between cancer and MASLD?

Cancer survivors may be at a higher risk of developing MASLD due to changes in their metabolism, lifestyle as well as side effects of cancer treatments. However, currently this is not known, even though it can increase the risk of future health complications.

The EVALUATE project

We are studying whether cancer survivors could be at increased risk of developing MASLD due to changes in metabolism, lifestyle factors, or the side effects of cancer treatments. However, this risk is not yet fully understood. The EVALUATE project seeks to fill this knowledge gap and improve future care for cancer survivors by including liver health as an issue for ongoing monitoring, if we find that there is a higher risk.  

What are the goals of EVALUATE study?

EVALUATE aims to:

  • find out how common it is for survivors of breast or colorectal cancer to develop fibrotic MASLD.
  • see which factors related to cancer or treatment that might increase the fibrotic MASLD risk.

We are conducting this research project in accordance with Swiss legal requirements. In addition, we adhere to all internationally recognized guidelines. The responsible ethics committee has reviewed and approved the research project.

Were patients and the public involved in the development of this project?
Research with and for the public

Ideas are to be contributed by everyone! For this project, we once again benefited from the support of our Panel for Patient and Public Involvement (PPI). PPI brings the lived experiences of patients and the public into research, making sure that studies are designed and carried out in ways that are clear, practical, and relevant. 

For example, in the EVALUATE study, the panel carefully reviewed the patient information leaflet and suggested changes to make it easier to understand. 

Find out more about our PPI group and the importance of this collaboration here.