Liver Cancer A Cancer You Can Catch
Cases of liver cancer surged in Australia during a 25-year window, say experts who call for a renewed focus on the cancer's link to viral hepatitis.
A study of liver cancer incidence and mortality in Victoria shows there were 3,500 cases diagnosed in the state from 1982 to 2007.
The number of liver cancer cases diagnosed each year tripled since the early 1980s, says Dr Benjamin Cowie from the Victorian Infectious Diseases Reference Laboratory and University of Melbourne.
'Liver cancer has the fastest increasing incidence and the joint fastest increasing mortality of any cancer in Australia," Dr Cowie says.
'Further research is urgently required into the nexus between chronic viral hepatitis and liver cancer to address this emerging public health priority."
The study also showed liver cancer cases were not evenly distributed geographically within Melbourne, with a third of all cases occurring in just six of Melbourne's local government areas.
Incidence in was highest in the North-Western and outer South-Eastern suburbs, with residents in these areas almost twice as likely to develop liver cancer compared to the Melbourne average.
The study will also show how liver cancer was often diagnosed late in its development when patients had a poor prognosis.
'Even in more recent years nearly one third of patients died within 30 days of diagnosis," Dr Cowie says.
This research comes as leading health experts from the Viral Hepatitis Conference warn that rates of liver cancer will soar if immediate action isn't taken to address hepatitis B and hepatitis C. The Auckland Statement, backed by leading virologists, clinicians and community groups and issued by the conference itself, calls for the number of people receiving treatment for hepatitis B and C each year to double.
Question:What is hepatitis?
Hepatitis means inflammation of the liver. It is possible for the body to clear itself of both hepatitis C and hepatitis B without medical intervention. After the initial or 'acute" phase of hepatitis B infection, most adults will clear the virus but around 5% will develop an ongoing or 'chronic" infection. If a child contracts hepatitis B, around 90% will develop a chronic infection. For hepatitis C, around 80% of those who contract the virus will develop a chronic infection. Without appropriate treatment, people with these chronic infections can progress to liver failure or liver cancer. Viral hepatitis is the No.1 cause of demand for liver transplants in Australia and NZ. Deaths from hepatitis-related liver cancer are growing at the same pace as deaths from melanoma and will treble by 2030.
Question:How do you catch it?
Viral hepatitis can be transmitted via sexual contact (hepatitis B) or blood-to-blood contact (hepatitis B and C). An infected woman can pass hepatitis B or C to her baby. The most common route of infection for hepatitis C is needle sharing by drug users, but other risky practices include getting a body piercing or tattoo. Travelling or having a medical procedure (particularly a blood transfusion) in a developing country also increases a person's risk. Migrant groups, indigenous Australians and NZ Maori also have a higher incidence of viral hepatitis.
Question:How many people are affected?
Around 2% of the Australian population, and almost 4% of New Zealanders, are thought to be living with chronic viral hepatitis. This amounts to more than half a million people - 270,000 thought to be living with chronic hepatitis C and almost 300,000 with chronic hepatitis B. More than 10,000 Australians and New Zealanders are newly diagnosed with hepatitis C each year, while the figure for hepatitis B is around 7,000. There are several hundred cases of hepatitis A diagnosed every year, though these infections are often short-lived and so are hard to detect.
Question:How do people know they have got viral hepatitis?
Often they don't. Because viral hepatitis can have no symptoms, many people remain unaware of their infection until they have complications of cirrhosis, when treatment options may be limited and survival poor. Therefore early detection and follow-up/treatment is essential. An estimated 10% of those living in Australia with chronic hepatitis C are unaware of their infection, whilst in NZ, this figure approaches 50%. In both Australia and NZ, at least a third of those living with chronic hepatitis B do not know it."
Question:Is there are vaccine?
There is a vaccine for hepatitis A (made available to healthcare workers, travellers, indigenous people and other at-risk groups). A hepatitis B vaccine is included among routine childhood vaccinations. There is no vaccine against hepatitis C.
Question:How is the disease currently treated?
A person can be cured of chronic hepatitis C infection but treatment can take up to a year. A 'double therapy" involving two drugs - ribavirin in tablet form and injections of interferon – is the current standard of care. This will not work for at least 20% of patients, however, and interferon can have toxic side effects. New oral drugs (telaprevir, boceprevir) that improve the effectiveness of conventional hepatitis C therapy have been approved for use in Australia and NZ, but subsidized access is yet to be granted. These are the first of a long line of new treatments becoming available over the next five years. For hepatitis B, conventional treatments are focused on controlling the infection rather than cure. To avoid liver damage, a person with chronic hepatitis B is likely to need tablets for the rest of their life.
Question:What are the barriers to treatment?
Waiting lists to access specialist services can be long. Current treatments require a long-term commitment, may be toxic, and offer no guarantee of a cure. Viral hepatitis drugs are also dispensed via specialist liver clinics, often within hospitals. Indigenous Australians and NZ Maori, people born in countries with a high prevalence and injecting drug users, have the highest incidence of viral hepatitis. These people face higher barriers to accessing health care.
Question:What is the link between viral hepatitis and organ demand?
More Australians and New Zealanders need a liver transplant as a result of viral hepatitis than for any other cause. Demand for donated livers outstrips the supply. Each year, an estimated 500 Australians and New Zealanders will die from complications of chronic viral hepatitis, but only 70 of the 250 liver transplants performed in both countries are in patients with chronic viral hepatitis. Around 10% of people who are placed on the waiting list for a donated liver will die before they receive one.
Question:What's the future of hepatitis C treatment?
Telaprevir and boceprevir are the first new drugs to combat hepatitis C in 20 years. They have been approved for use in Australia and NZ, though subsidized access is not yet available. A decision on listing the drugs on Australia's Pharmaceutical Benefits Scheme (PBS) and NZ's PHARMAC is pending. The drugs have been shown to improve the effectiveness of conventional therapy, even in those who have failed treatment in the past. They also target a strain of hepatitis C known to be particularly tough to beat (genotype 1). Ultimately, the drugs could lead to a therapy that does need interferon and so would have less risk of toxic side effects. Other experimental oral drugs, still in the clinical trial phase, also show great promise in combating chronic hepatitis C without any need for interferon.
Question:What is the Auckland Statement on Viral Hepatitis?
The Auckland Statement has been issued by the 8th Viral Hepatitis Conference and is a call for urgent action to curb the rate of new infections and stop the rising death toll arising from hepatitis B and C. It is backed by leading virologists, clinicians and community groups and sets specific targets:
halve the incidence of new hepatitis C infections by doubling the amount of new injecting equipment distributed in the general community and implementing NSPs in prisons;
apply consistent approaches to funding hepatitis B vaccinations for all those at greatest risk;
ensure at least 80% of all people living with hepatitis B or hepatitis C are diagnosed;
guarantee that 5% of people living with hepatitis C receive antiviral treatment each year;
guarantee that 10% of people living with hepatitis B receive antiviral treatment.
For more information visit www.aucklandstatement.com