Primary liver cancer- facts and figures of a preventable cancer

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1 Primary liver cancer- facts and figures of a preventable cancer Prof. Patrizia Burra EU Policy Councillor European Association for Study of the Liver

2 EASL History Founded in ,000 + members Attracts the foremost hepatology experts Has impressive track record promoting research in liver disease, supporting wider education, and promoting changes in European liver policy.

3 Prevalence of HBV in the world 350 million chronically infected Source: CDC (Center for Disease Control) Data until 2006.

4 HBV Infection: Natural History 2-6% infected patients develop chronic hepatitis 20-30% 2-10% per year Cirrhosis 5-year 10% Hepatocellular carcinoma Hatzakis JVH 2011 Duberg JVH 2008 Garcia-Fulgueiras EJGH 2009 Marcellin JH 2008

5 Prevalence HCV 180 million people infected worldwide World Health Organization <1 % % % 5 10 % > 10 % NA (

6 HCV Infection: Natural History 85% infected patients develop chronic hepatitis 10-20% years Compensated cirrhosis - Asymptomatic patients - Normal or slightly increased blood tests - No significant clinical event 5-10 years Hepatocellular carcinoma Decompensated cirrhosis - Symptomatic patients - Alterated blood tests - Esophageal varices, ascites, peritonitis, encephalopathy Hatzakis JVH 2011

7 HCV/HCC Kanwal, Gastroenterology 2011

8 HCV and HBV-related mortality in Spain HCV could have caused 70% of HCC deaths 50% of cirrhosis deaths HBV could have caused 10% of HCC deaths 13% of cirrhosis deaths Globally 1.5% of total deaths in Spain in 2000 Garcia-Fulgueiras A. Eur J Gastr Hepatol 2009

9 How Big a Problem? 500,000,000 chronically infected 350 million HBV 150 million HCV 1,000,000 deaths per year 600,000 HBV 350,000 HCV 57% of cirrhosis 30% HBV 27% HCV 78% of Hepatocellular carcinoma 53% HBV 25% HCV

10 Patients With Disease Progression (%) Treatment Prevents Decompensation & Cancer Placebo (n = 215) Treated (n = 221) HBV Time After Randomization (Months) Liaw YF, et al. N Engl J Med. 2004;351:

11 Treatment Prevents Decompensation & Cancer HCV Bruno Hepatology 2007

12 Lack of awareness (2010 ELPA Survey) 90% of infected people in EU are unaware of their condition. Among diagnosed individuals: 80% had never heard of viral hepatitis at the time of diagnosis 73% did not know they were at risk of transmitting the infection

13 HBV Vaccination Zanetti Vaccine 2008

14 HBV SCREENING AND EARLY TREATMENT OF MIGRANTS 1.3 million migrants in The Netherlands (8% of the Dutch population, 2006) Estimated HBsAg prevalence of 3.35%, HBsAg positive persons Screening: the incremental cost-effectiveness ratio (ICER) is per QUALY gained Treatment: the ICER ranged from to Veldhuijzen Gastroenterology 2010

15 Modifiable and Nonmodifiable Factors in Disease Progression in Chronic Hepatitis C Age Steatosis Male sex Race FIBROSIS PROGRESSION Alcohol Iron overload Metabolic factors (Obesity, Diabete mellitus, Insulin resistance) Missiha Gastroenterology 2008

16 Impact of New Treatments and Screening Reduction in mortality HCV Genotype 1 25% 20% +202% +83% +120% +384% 15% +19% +15% +280% +102% 10% 5% +25% +23% +22% +27% 0% Belgium France Germany Italy Spain UK With current treatments With new treatments including PI With new treatments including PI + reinforcement in HCV screening and treatment

17 The Incidence and Epidemiology of Hepatocellular Carcinoma: A Global and Regional Perspective ALAN P. VENOOK, CHRISTOS PAPANDREOU, JUNJI FURUSE, LAURA LADRÓN DE GUEVARA The Oncologist 2010 SE 11.6 WE 6.2 EE 5.5 NE 3.4 Global variation in liver cancer incidence rates. From Parkin DM, Bray F, Ferlay J et al. Global cancer statistics, CA Cancer J Clin 2005;55:74 108, with permission from John Wiley & Sons. Data are estimates for the year 2002 from the GLOBOCAN database of the International Agency for Research on Cancer. Classification of incidence was based on data in males ( a >20 per 100,000, b per 100,000, c 5 10 per 100,000, d <5 per 100,000).

18 500,000,000 chronically infected 350 million HBV 150 million HCV 1,000,000 deaths per year 600,000 HBV 350,000 HCV 57% of cirrhosis 30% HBV 27% HCV 78% of Hepatocellular carcinoma 53% HBV 25% HCV Global Burden

19 Policy Goals EU Council Recommendation Screening Surveillance

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21 Thank you!