Liver cancer is the sixth most common cancer globally, and the third most common cancer causing death. Liver cancer incidence in Australia is low compared with other regions of the world, but age-standardised rates have been steadily increasing over the past three decades and are predicted to continue to rise.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the leading causes of liver cancer globally.Alcohol, being overweight or obese, and aflatoxins are also causes of liver cancer. Other risk factors of increasing importance are type 2 diabetes, non-alcoholic fatty liver disease (NAFLD) and haemochromatosis.
The majority of liver cancers are preventable through primary prevention strategies to reduce or eliminate transmission of HBV and HCV, and through early detection and appropriate management of infected individuals.
Neonatal vaccination is the most effective preventive approach against HBV. Other primary prevention strategies include vaccination of adults in high-risk groups, ensuring a safe blood supply, universal precautions in healthcare settings and harm-reduction approaches to reduce transmission through sharing injecting drug equipment. Strategies to curb alcohol intake and reduce obesity (and hence type 2 diabetes and NAFLD) will also reduce future liver cancer burden.
Secondary prevention of hepatitis-related liver cancer aims to reduce the proportion of infected people progressing to liver cirrhosis and cancer. Successful strategies include: screening high-risk groups to detect infected individuals earlier; antiviral therapies, which can effectively control HBV infection and eradicate HCV; and ongoing surveillance and management of infected individuals.
Improving health outcomes for people with hepatitis infection relies on early detection and appropriate treatment. A major barrier to achieving this is a lack of understanding and awareness of hepatitis among both the public and health practitioners. Countering the myth that people infected with hepatitis can be ‘healthy carriers’ and improving awareness of the available treatment options for hepatitis are important strategies to reduce the burden of hepatitis-related liver disease.
This chapter of Cancer Council Australia’s National Cancer Prevention Policy discusses liver cancer's impact and risk factors, and presents the evidence on primary and secondary prevention strategies. It also covers the current policy context in Australia and summarises Cancer Council Australia's recommended, evidence-based policy priorities to reduce the burden of liver cancer in Australia.