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Impact

Impact

Liver Cancer Prevention Policy

Global impact

Liver cancer is the fourth most common cause of death from cancer worldwide, with an estimated 781,631 deaths in 2018 and the sixth most common cancer with 841,080 new cases diagnosed worldwide [1]. This results in a high mortality to incidence ratio (0.93) [1]. Internationally, around 85% of new cases occur in Eastern, South-Eastern and South-Central Asia, Northern Africa, North and South America as well as Southern Europe [1].

This geographical variation in the incidence of liver cancer is largely explained by the prevalence of the major risk factors - hepatitis C virus (HCV) and hepatitis B virus (HBV) infection - as explored in the Causes section of this chapter.

Liver cancer in Australia

Liver cancer caused 1,864 deaths in 2016, elevating it into the top 10 causes of cancer deaths[2]. Liver cancer is the fastest growing cause of cancer death in Australia[2]. However, this does not need to be the case as approximately 65% of liver cancer deaths in Australia are potentially preventable [3]. Liver cancer is rarely detected early and consequently has a high mortality rate. The five-year relative survival rate for people diagnosed with liver cancer in 2010-2014 was 18%[4].

Liver cancer incidence is relatively low in Australia compared with other regions of the world but is growing faster than that of any other cancer in Australia[5]. In 2015, 2,079 people were diagnosed with primary liver cancer [6]. In Australia, age-standardised liver cancer incidence rates are highest in some overseas-born populations[7], particularly those from countries where HBV and HCV are endemic. The incidence of liver cancer varies by state with the highest incidence reported in the Northern Territory[2].

Compared with the rest of the population, Aboriginal and Torres Strait Islander people are 2.4 times more likely to be diagnosed with liver cancer and are 2.4 times more likely to die of liver cancer [8]. Aboriginal and Torres Strait Islander people have a disproportionately lower five-year relative survival rate of 7.7% in 2010-2014[4]. This reflects a greater burden of chronic liver disease on Aboriginal and Torres Strait Islander populations, including high rates of chronic HBV and HCV infections [9][10].

Trends

Age-standardised rates of liver cancer have been steadily increasing over the past three decades. Incidence has increased from 1.8 cases per 100,000 people in 1982 to 7.6 cases per 100,000 in 2015[6]. Age-standardised liver cancer incidence – particularly hepatitis B related liver cancer[11] – is expected to continue to rise over the next two decades. Incidence in Australia is projected to almost double by 2030, from 1,076 cases in 2005 to 3,413 in 2030 [12]. This continuing rise is mainly attributed to a large number of people living with chronic hepatitis who are not receiving appropriate treatment and care, immigration from hepatitis endemic countries and the slow disease progression from chronic hepatitis infection to liver cancer [7][11][13][14].

Economic costs

There is little data on the direct economic cost of liver cancer in Australia. The figures below for the economic costs associated with HBV and HCV in Australia are not comparable as different methodologies were used in the studies.

In 2009-2010, Government spending on HBV and HCV agents through the Pharmaceutical Benefits Scheme on 10 hepatitis drugs amounted to almost $88 million. With the listing of new treatments for HCV, in 2016 the Government committed more than $1 billion over five years to HCV treatments[15].

In 2008, the direct costs of managing and treating people with HBV infection in Australia were estimated at $171.8 million[16]. The average cost of managing each patient with chronic HBV infection and hepatocellular carcinoma was estimated at nearly $14,000 (without therapy) to about $19,000 (with therapy)[16].


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References

  1. Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Pineros M, et al.. Global Cancer Observatory: Cancer Today. [homepage on the internet] Lyon, France: International Agency for Research on Cancer; 2018 [cited 2020 Apr 24]. Available from: https://gco.iarc.fr/today.
  2. Australian Institute of Health and Welfare. Cancer in Australia 2019. Canberra: AIHW; 2019 [cited 2020 Apr 29]. Report No.: Cancer series no.119.Cat. no. CAN 123. Available from: https://www.aihw.gov.au/getmedia/8c9fcf52-0055-41a0-96d9-f81b0feb98cf/aihw-can-123.pdf.aspx?inline=true.
  3. Wilson LF, Antonsson A, Green AC, Jordan SJ, Kendall BJ, Nagle CM, et al. How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. Int J Cancer 2018 Feb 15;142(4):691-701 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28983918.
  4. Australian Institute of Health and Welfare. Colorectal and other digestive-tract cancers. Canberra: AIHW; 2018 [cited 2020 Apr 29]. Report No.: Cancer series no. 114. Cat. no. CAN 117. Available from: https://www.aihw.gov.au/getmedia/892d43f7-ab5d-48fe-9969-129f138687f3/aihw-can-117.pdf.aspx?inline=true.
  5. Australian Institute of Health and Welfare. Cancer incidence projections: Australia, 2011 to 2020. Cancer Series no. 66. Cat. No. CAN 62. Canberra: AIHW; 2012.
  6. Australian Institute of Health and Welfare. 2018 Cancer Data in Australia; Australia Cancer Incidence and Mortality (ACIM) workbooks: liver cancer. Canberra: AIHW; 2018 [cited 2019 Jul 25] Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia/acim-books.
  7. Law MG, Roberts SK, Dore GJ, Kaldor JM. Primary hepatocellular carcinoma in Australia, 1978-1997: increasing incidence and mortality. Med J Aust 2000 Oct 16;173(8):403-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11090031.
  8. Australian Institute of Health and Welfare. Cancer in Aboriginal & Torres Strait Islander people of Australia. [homepage on the internet] Canberra: AIHW; 2018 Available from: https://www.aihw.gov.au/reports/cancer/cancer-in-indigenous-australians/contents/cancer-type/cervical-cancer-c53.
  9. Graham S, Guy RJ, Cowie B, Wand HC, Donovan B, Akre SP, et al. Chronic hepatitis B prevalence among Aboriginal and Torres Strait Islander Australians since universal vaccination: a systematic review and meta-analysis. BMC Infect Dis 2013 Aug 31;13:403 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24004727.
  10. The Kirby Institute. Bloodborne viral and sexually transmissable infections in Aboriginal and Torres Strait Islander people: Annual Surveillance Report 2017. Sydney: University of New South Wales; 2017 [cited 2020 Apr 29] Available from: https://kirby.unsw.edu.au/sites/default/files/kirby/report/KirbyInst_Indigenous_ASR2017-compressed.pdf.
  11. Nguyen VT, Razali K, Amin J, Law MG, Dore GJ. Estimates and projections of hepatitis B-related hepatocellular carcinoma in Australia among people born in Asia-Pacific countries. J Gastroenterol Hepatol 2008 Jun;23(6):922-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17608637.
  12. Valery PC, Laversanne M, Clark PJ, Patrick JL, McGlynn KA, Bray F. Projections of primary liver cancer to 2030 in 30 countries worldwide. Hepatology [cited 2018 Feb];67(2):600-611 Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Projections+of+primary+liver+cancer+to+2030+in+30+countries+worldwide.
  13. Infection in Endoscopy Study Group, Tawk HM, Vickery K, Bisset L, Lo SK, Selby W, et al. The current pattern of hepatitis B virus infection in Australia. J Viral Hepat 2006 Mar;13(3):206-15 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16475997.
  14. Dore G, Wallace J, Locarnini S, Desmond P, Gane E, Crawford D. Hepatitis B in Australia: responding to a diverse epidemic. Sydney: Australian Society for HIV Medicine; 2007 Available from: http://vhba.org.au/sites/default/files/Hep%20B%20in%20Australia%20-%20responding%20to%20a%20diverse%20epidemic.pdf.
  15. Gartrell A. Turnbull government to spend $1 billion on hepatitis C 'miracle cures' for all. [homepage on the internet] Sydney: The Sydney Morning Herald; 2015 Dec 19 [cited 2020 Apr 30]. Available from: https://www.smh.com.au/politics/federal/turnbull-government-to-spend-1-billion-on-hepatitis-c-miracle-cures-for-all-20151219-glrib0.html.
  16. Butler JRG, Korda RJ, Watson KJR, Watson DAR. The impact of chronic hepatitis B in Australia: projecting mortality, morbidity and economic impact. Canberra: Australian Centre for Economic Research on Health; 2009 Sep Available from: http://www.acerh.edu.au/publications/ACERH_RR7.pdf.
Liver Cancer
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