B Positive – all you wanted to know about - ASHM

Foreword
in nsW, just seven cancers—those of prostate, breast, bowel, lung, melanoma and non-
Hodgkin’s lymphoma, and cancers of unknown site—account for 68% of all cancers. in turn,
they account for 60% of cancer deaths. the national response to cancer is quite rightly focused
on these seven cancers.
However, what is true for the population taken as a whole may not be true for all subgroups of
that population. the cancer council nsW report Cancer Incidence in New South Wales Migrants
1991-2001 demonstrates that migrants from some countries have quite a different cancer
profile from that of the australian-born population. 1 Liver cancer is a case in point. although the
overall share of cancer in nsW migrants (24.5%) is commensurate with their representation in
the population, 46% of all primary liver cancers in nsW are diagnosed in overseas-born people.
there are several striking features in the epidemiology of liver cancer in nsW. firstly, it is the
most rapidly increasing of all cancers. between 1995 and 2004, primary liver cancer in nsW
increased by 59% in males and 116% in females. secondly, it is among the most fatal cancer,
with a five-year relative survival of 15% akin to that of lung and pancreatic cancer. thirdly, in
comparison to the australian-born population, immigrants from countries with high prevalence
rates for chronic hepatitis b virus (HbV) infection are at a sixfold or greater risk of developing
liver cancer. in nsW, liver cancer exhibits a striking pattern of geographic clustering, reflecting
in part differences in neighbourhood ethnic composition.
People with chronic HbV infection incur a high burden of chronic disease and premature death.
around 30% will die of liver cancer or liver disease. the population at risk will continue to swell as
immigration from HbV endemic countries continues and increases, and it will be some decades
before universal infant HbV vaccination programs in those countries substantially reduce the
rates of chronicity in adult populations. this situation poses a challenge to the convenient notion
that australia’s program of universal childhood vaccination and protection of the blood supply
are a sufficient response. Presently, there is no systematic approach to vaccinating susceptible
people within high-risk communities.
the difference between australia’s response to hepatitis b and the national Hepatitis c strategy
is dramatic. in stark contrast to the patchy and unfocused response to HbV, the management
of hepatitis c includes a comprehensive response based on building partnerships; involving
affected communities; preventing hepatitis c virus (HcV) transmission; providing clinical
treatment, and community care and support to those with the infection; providing training and
education; and undertaking research and disease surveillance.
a systematic response to HbV is both feasible and affordable. the long latency period between
childhood HbV infection and the development of liver-related disease provides an ample
window of opportunity for case finding, especially among known high-risk groups. Monitoring
6 b Positive – all you wanted to know about hepatitis b: a guide for primary care providers