Asia-Pacific’s medical professionals are warning that without major changes to screening and treatment for chronic liver disease, the region risks losing its battle to contain a rapidly increasing cancer which is already the second leading cause of cancer deaths globally.
Liver cancer in Australia has increased almost 50% in the previous decade and the number of deaths has nearly doubled (778 in 2001 to 1,423 in 2011).*
Speaking at the 2014 meeting of the Asian Pacific Association for the Study of Liver (APASL) in Brisbane this week, Associate Professor Amany Zekry explained that liver cancer is the end stage of chronic liver disease, which includes diseases such as hepatitis B and C as well as non-alcoholic fatty liver disease (NAFLD).
“In the Asia Pacific region it is estimated that 340 million people are affected by viral hepatitis alone and NAFLD, due to obesity, is becoming a key cause of chronic liver disease,” she added.
NAFLD affects about 5.5 million Australians and is increasingly affecting younger people with a West Australian study finding NAFLD affects about 13% of 17 year olds.
Professor Zekry, chair of the Australian Liver Association, said NAFLD was also increasing across the Asia Pacific region as many countries adopt a more westernised diet and lifestyle.
In China, the prevalence of fatty liver increased from about 14% in 1996 to 23% in 2004; it affects about 22% of people in Malaysia, 30% in Japan and 30% in Sri Lanka.
“Strategies to increase screening and treatment programs in high-risk populations are urgently needed across the region, including Australia,” said Prof Zekry.
"Policy makers are starting to take action against obesity, but there is no emphasis as yet on the importance of screening for liver disease, such as doctors following up on abnormal liver tests in people with obesity and diabetes.”
Prof Zekry added that without these protocols, measures to prevent the progression of liver disease and risk of liver cancer could not be implemented.
“For viral hepatitis, effective vaccination programs are vital to prevent hepatitis B and its complications such as cirrhosis and liver cancer. For instance, in Taiwan a nationwide hepatitis B vaccination program that has proven very successful in reducing the risk of liver cancer,“ said Prof Zekry.
“With hepatitis B and C infections, new treatments are offering exceptionally high rates of cure which will also help reduce the rates of liver scarring and hopefully, the burden of liver cancer.”
“Better treatment prevents transmission of the virus, but people with hepatitis need to be diagnosed and referred to engage with treatment. That’s an issue in Australia, across the region and globally.”
In Australia, less than 2% of people with hepatitis C come forward for treatment for various reasons including perceived stigma, poor understanding of how the disease progresses, fear of side effects from treatment and other existing conditions.
“Our optimism surrounding significant treatment advances is tempered by the scale of the problem and the low profile of liver disease. Controlling the epidemic of liver cancer requires much greater public awareness of the problem and its preventable risk factors," said Prof Zekry.
“Chronic liver disease is one of the biggest health issues in the Asia Pacific region. APASL 2014 is an opportunity to come together to encourage a more effective public policy response in prevention and access to services across the region.”
*Ref: Australian Institute of Health and Welfare (AIHW) 2014. Australian Cancer Incidence and Mortality (ACIM) books.
Source - APASL
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