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 . This results in a high mortality to incidence ratio (0.93) . 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 .
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. Liver cancer is the fastest growing cause of cancer death in Australia. However, this does not need to be the case as approximately 65% of liver cancer deaths in Australia are potentially preventable . 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%.
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. In 2015, 2,079 people were diagnosed with primary liver cancer . In Australia, age-standardised liver cancer incidence rates are highest in some overseas-born populations, 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.
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 . Aboriginal and Torres Strait Islander people have a disproportionately lower five-year relative survival rate of 7.7% in 2010-2014. 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 .
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. Age-standardised liver cancer incidence – particularly hepatitis B related liver cancer – 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 . 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 .
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.
In 2008, the direct costs of managing and treating people with HBV infection in Australia were estimated at $171.8 million. 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).
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