Dr Julie Wang – GP and researcher, Burnet Institute
with Jody Simmons – Research Assistant, Cancer Council Victoria
Published 6 August 2013
More than 350 million people are living with chronic hepatitis B (CHB). The hepatitis B virus (HBV) can cause liver cancer, chronic liver damage and cirrhosis. HBV is the second-most common known human carcinogen after tobacco. In fact, individuals with CHB are 200 times more likely to develop liver cancer than uninfected people. Eighty per cent of liver cancers globally are caused by viral hepatitis infections. Liver cancer has a poor prognosis – only around ten to sixteen per cent of patients are expected to live beyond five years after diagnosis.
Hepatitis B is spread via blood or bodily fluid contact with an infected person, with the main cause of transmission being from mother to child at birth.
Some other modes of transmission of the virus include:
- From close person-to-person contact, especially early childhood in childhood (for example via open sores and cuts)
- parenteral transmission or mucosal exposure to infected blood or body fluids, including the sharing of injecting drug equipment, toothbrushes or razor blades, tattooing equipment, body piercing equipment and acupuncture equipment
- needle-stick injury, for example, in a health care setting
- sexual contact.
In Australia, people at higher risk of hepatitis B include:
- people from Asia-Pacific region where the disease is common
- Aboriginal and Torres Islanders
- men who have sex with men
- people who are in or have been in custodial settings
- people with a history of injecting drug use
- family members, people who live with or, sexual partners of someone who has chronic hepatitis B
- sex workers
- people with hepatitis C, HIV or both
- people undergoing dialysis
- people who are about to start chemotherapy or immunotherapy.
Hepatitis B and liver cancer in Australia
- Liver cancer is Australia’s fastest growing cause of cancer-related death, jumping three spots in three years to become Australia’s ninth most fatal cancer. Deaths from liver cancer are expected to double over the next decade.
- An estimated 218,000 Australians are living with CHB, however approximately 44% remain undiagnosed in Australia, which facilitates ongoing transmission and progression of the disease. Without diagnosis and treatment, up to one in four people with CHB will go on to develop liver cancer.
- The rate of liver cancer in Australia is expected to double over the next decade unless drastic action is taken.
- Only 3% of those diagnosed with CHB who require treatment are receiving it.
- Most of those who present with liver cancer related to CHB present late in the disease and therefore have poor outcomes. In New South Wales, one in four deaths from liver cancer associated with viral hepatitis were only diagnosed with HBV or co-infection with hepatitis C virus six months before death.
- At-risk groups face the greatest barriers to healthcare often due to a lack of understanding of the disease and its effects, as well as cultural and linguistic differences.
Effective vaccine and treatment can reduce the burden of hepatitis B and liver cancer
There is a safe and effective vaccine that has been available since 1982. However, vaccination programs in Australia have limited impact on the prevalence of CHB and liver cancer due to the high level of migration of people from high-prevalence CHB areas.
Currently there is no cure for HBV, but there are good antiviral drugs that significantly reduce the progression and development of complications of chronic infection, including liver cancer and liver cirrhosis. Combined antiviral treatment and liver cancer surveillance is more cost-effective than colon cancer and cervical cancer screening programs.
What can GPs do?
Primary health providers play a vital role in reducing the risk of liver cancer and improving the impact of CHB on affected communities through early detection, monitoring and appropriate management of CHB.
Innovative study to help GPs reduce the proportion of untested, untreated and unvaccinated patients
Cancer Council Victoria are working with the Burnet Institute, Victorian Infectious Diseases Reference Laboratory and the University of Melbourne to pilot a new computer program aimed to support GPs to reduce the impact of CHB within their patient population. The program uses existing practice software records and past test results to identify patients of Asia-Pacific, Aboriginal or Torres Strait Islander background, or people with a history of injecting drug use. The pilot program helps GPs to recall patients at risk of CHB to have appropriate testing or vaccination for HBV.
Four general practices across Melbourne have been involved in the study, two of which were expected to have a large at-risk population, the other two expected to have a moderate- and small-sized at-risk populations. Results indicate that there many people at high risk of CHB who have not had testing for, or vaccination against, HBV.