Liver Cancer Prevention Policy
Policy and strategies aimed at controlling major risk factors such as hepatitis B virus (HBV) and hepatitis C virus (HCV) infections have significant potential to reduce Australia's current and future liver cancer burden.
As described in the Prevention and Screening sections of this chapter, the impact of HBV and HCV in Australia has been successfully reduced through ensuring a safe blood supply, implementing a national HBV immunisation program and making treatments for chronic HBV and HCV available through the Pharmaceutical Benefits Scheme.
National strategies and guidelines
Australia has a number of national strategies for hepatitis control, and was the first country in the world to have a national strategic response to hepatitis C. Major frameworks include:
- Fifth National Hepatitis C Strategy 2018–2022;
- Third National Hepatitis B Strategy 2018–2022;
- National Hepatitis C Testing Policy ; and
- National Hepatitis B Testing Policy
These frameworks, while broadly supported in principle, are not underpinned by implementation plans, systematic reporting and auditing and direct program funding related to specific services.
Hepatitis B and hepatitis C infections are notifiable conditions; however, under-diagnosis and under-reporting of HBV and HCV infections mean that hepatitis incidence and hepatitis-related disease burden are underestimated . Current prevalence estimates rely on antenatal screening data, opportunistic laboratory surveys, and estimates of at-risk populations.
Hepatitis B vaccination
Routine adolescent HBV vaccination was introduced in 1997, and universal infant vaccination began in 2000. Uptake among Australian children is high; 96% of children aged 24 months of age at 30 September 2015 had received the full course (three doses) (NCIRS 2018). Hepatitis B birth dose is also recommended for all infants born in Australia; current uptake is not systematically reported nationally. Hepatitis B immunoglobulin is recommended in addition to birth dose vaccination to newborns of mothers with HBV infection and is around 85–95% effective in preventing vertical transmission. National coverage of HBV immunoglobulin among infants born to women living with chronic HBV is not known.
HBV vaccination is recommended for susceptible adults in high-risk groups, such as close contacts of a person with hepatitis B, migrants from endemic countries and Aboriginal and Torres Strait Islander Australians and those who are unvaccinated. However, there is no systematic approach to ensure these high-risk groups are vaccinated.
Australia does not have population-based screening programs for HBV, HCV or liver cancer as currently there is insufficient evidence to support such programs in Australia (See Principles of screening). However, there is evidence to support targeted screening in priority populations . Mandatory or compulsory hepatitis testing is required under policy or legislation for people wanting to participate in certain activities or have access to certain services, e.g. as a condition of blood, tissue and organ donation; to enter armed forces training or service; and before performing exposure-prone procedures in some healthcare settings. National HBV and HCV testing policies have identified ‘priority populations’ for testing such as people born in countries of high HBV prevalence. 
Treatment of hepatitis B and C
Antiviral treatments are available for HBV and HCV infections. Treatment of HBV, which must continue indefinitely for most individuals, substantially reduces the risk of liver cancer in those treated within a few years of initiation.  Treatment of HCV is curative in approximately 95% of individuals after 12 weeks of oral antiviral treatment, which has been available on the PBS since March 2016. These HCV treatments have also been associated with substantial mortality benefit and prevention of liver cancer in those treated .
- Australian Government Department of Health and Ageing. National hepatitis B strategy 2010–2013. Canberra: DoHA; 2010 Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-national-strategies-2010-hepb/$File/hepb.pdf.
- Australian Government Department of Health and Ageing. Third national hepatitis C strategy 2010–2013. Canberra: DoHA; 2010 Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-national-strategies-2010-hcv/$File/hcv.pdf.
- National Centre for Immunisation Research and Surveillance. Vaccine coverage estimates - all children. [homepage on the internet] Westmead, NSW: NCIRS; 2018 [cited 2020 Apr 29]. Available from: http://www.ncirs.edu.au/provider-resources/coverage-information/coverage-estimages/.
- Petersen KM, Bulkow LR, McMahon BJ, Zanis C, Getty M, Peters H, et al. Duration of hepatitis B immunity in low risk children receiving hepatitis B vaccinations from birth. Pediatr Infect Dis J 2004 Jul;23(7):650-5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15247604.
- Lee C, Gong Y, Brok J, Boxall EH, Gluud C. Hepatitis B immunisation for newborn infants of hepatitis B surface antigen-positive mothers. Cochrane Database Syst Rev 2006 Apr 19;(2):CD004790 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16625613.
- Kripke C. Hepatitis B vaccine for infants of HBsAg-positive mothers. Am Fam Physician 2007 Jan 1;75(1):49-50 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17225703.
- Zou H, Chen Y, Duan Z, Zhang H. Protective effect of hepatitis B vaccine combined with two-dose hepatitis B immunoglobulin on infants born to HBsAg-positive mothers. PLoS One 2011;6(10):e26748 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22053208.
- Australian Government Department of Health and Ageing. The Australian immunisation handbook. 10th edition. Canberra: DoHA; 2013 Available from: http://health.gov.au/internet/immunise/publishing.nsf/Content/EE1905BC65D40BCFCA257B26007FC8CA/$File/handbook10.pdf.
- Eckman MH, Kaiser TE, Sherman KE. The cost-effectiveness of screening for chronic hepatitis B infection in the United States. Clin Infect Dis 2011 Jun;52(11):1294-306 Available from: https://www.ncbi.nlm.nih.gov/pubmed/?term=Eckman.+The+cost-effectiveness+of+screening+for+chronic+hepatitis+B+infection+in+the+United+States.
- National HBV Testing Policy Expert Reference Committee. National hepatitis B testing policy. Canberra: Australasian Society for HIV Medicine; 2012 Available from: http://www.ashm.org.au/images/HBV/HBV_TESTING_POLICY_FORMATTED_V1.1_PRINT.pdf.
- National HCV Testing Policy Expert Reference Committee. National HCV testing policy. Sydney: Australian Society for HIV Medicine; 2012 [cited 2012 Aug]. Sponsored by Australian Government Department of Health and Ageing. Available from: http://testingportal.ashm.org.au/images/HepB_TESTING_POLICY_REVIEW2015_v1.2.pdf.
- Papatheodoridis GV, Chan HL, Hansen BE, Janssen HL, Lampertico P. Risk of hepatocellular carcinoma in chronic hepatitis B: assessment and modification with current antiviral therapy. J Hepatol 2015 Apr;62(4):956-67 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25595883.
- Pharmaceutical Benefits Scheme. General statement for drugs for the treatment of Hepatitis C. [homepage on the internet] Canberra: Commonwealth of Australia; 2017 [cited 2020 Apr 29]. Available from: http://www.pbs.gov.au/info/healthpro/explanatory-notes/general-statement-hep-c.