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Ignorance of hepatitis retards war on liver cancer

Prof Mark Thursz (Secretary General of EASL) and Mr Achim Kautz (Vice President, ELPA) address a letter to the editor of the Financial Times highlighting that lack of awareness of viral hepatitis B and C again hinders the fight against liver cancer.

Sir, While we are delighted to see liver cancer included in your overview on cancer prevention, we would like to point out that hepatitis B vaccination does not solve the problem in its entirety, since it does not address those who are already infected not only with hepatitis B but also viral hepatitis C (“Cruel hand of fate still has a role to play”, FT Health, September 28).

A recent study conducted in Spain attributed 1.5 per cent of total deaths in Spain in 2000 to primary liver cancer. Out of those, 70 per cent had a prior infection with hepatitis C and 10 per cent with hepatitis B. This is why, in addition to both childhood and adult vaccination against hepatitis B, it is vital for public health authorities and medical doctors to identify those at risk of contracting the virus and have them tested, so that their infection can be fought effectively before follow-on diseases, such as cirrhosis or cancer, occur. People at risk of viral hepatitis B and C include those who have received blood before 1991, those who have shared needles for intravenous drug use or even used an aspiration tube to “snort” illicit substances; those who have come in contact with infected blood (needle stick injuries), those who have undergone medical or dental surgery in insufficiently sterilised environments; those who have had a tattoo, piercing or acupuncture done with non-sterile equipment; those who have had unprotected sex; those where transmission occurred during pregnancy or at birth; those who have elevated liver enzymes; and those who have lived for an extended period in countries with high prevalence.

Unfortunately, awareness of viral hepatitis B and C is low. A study conducted by the European Liver Patients Association in 2009 revealed that 80 per cent of those surveyed had not heard of viral hepatitis by the time of their diagnosis and 73 per cent did not know they were at risk of transmitting the infection.

This situation needs to change urgently if we want to help reduce the incidence of primary liver cancer and the resulting deaths (47,147 in EU-27 in 2008, according to the World Health Organisation). The low awareness regarding the seriousness of the liver disease epidemic applies not only to patients and the public but also to policy makers, whose ignorance of the situation can be noted from its remarkable absence from the millennium development goals.

Letter to the Editor published in the Financial Times, October 5, 2012

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