Recognising the role of infection: preventing liver cancer in special populations

摘要

Hepatitis B virus is the second most important known human carcinogen after tobacco. Increasing prevalence of chronic viral hepatitis in Australia has resulted in rapidly rising liver cancer incidence. Prevalence of Hepatitis B virus, and consequently incidence of liver cancer, is highest in migrants born in Hepatitis B virus endemic areas, and in Aboriginal and Torres Strait Islander people. Often Hepatitis B virus is acquired at birth or in early childhood, when the likelihood of developing chronic infection is high. Globally the best preventative strategy for Hepatitis B virus associated liver cancer is universal infant vaccination, but vaccination in Australia will prevent a very small proportion of future liver cancer. Approximately 170,000 Australians live with chronic Hepatitis B virus infection. A comprehensive program of Hepatitis B virus management, including liver cancer surveillance and appropriate antiviral therapy, is very likely to be cost-effective as a cancer prevention program. Under-treatment of chronic Hepatitis B virus infection in Australia partly relates to the high proportion of affected people who are from culturally and linguistically diverse backgrounds, or are Aboriginal or Torres Strait Islander people. Health inequities and reduced access to appropriate diagnosis, treatment and care must be addressed as a matter of priority to address one of the fastest increasing causes of cancer death in Australians.