Building modern hepatocellular carcinoma surveillance programmes: taking steps to address a leading cause of liver cancer death

Buildingmodernhepatocellularcarcinomasurveillanceprogrammes: takingstepstoaddressaleadingcauseoflivercancerdeathinAsia Supportedby Contents 2Contents 3Aboutthereport 4Executivesummary 6Chapter1.TheevolvingburdenofhepatocellularcarcinomainAsia 8Chapter2.Thevalueofhepatocellularcarcinomasurveillance 14Chapter3.Addressinghepatocellularcarcinomasurveillance:currentapproachesandcommonchallenges 20Chapter4.Building21stCenturyhepatocellularcarcinomasurveillanceprogrammes 23Conclusionsandcalltoaction 24References Aboutthereport Buildingmodernhepatocellularcarcinomasurveillanceprogrammes:takingstepstoaddressaleadingcauseoflivercancerdeathinAsiaisanEconomistImpactreport,supportedbyRocheDiagnosticsAsiaPacificPteLtd. Theresearchincludedaliteraturereviewandinterviewswithregionalexpertsintheliverdiseasespace.Wewouldliketoextendourthankstothefollowingindividuals(listedalphabetically)fortheirtime,expertiseandinsights,whichwereessentialtothecreationofthisreport: •DoanDao,AssistantProfessorandDirector,CenterofExcellenceforLiverDiseaseinVietnamandAssistantProfessorofMedicine,DivisionofGastroenterology&Hepatology,JohnsHopkinsUniversity,Maryland •JacobGeorge,ProfessorofHepaticMedicine,HeadoftheDepartmentofGastroenterologyandHepatology,WestmeadHospital,Sydney;DirectoroftheStorrLiverCentre,WestmeadInstituteofMedicalResearch,WestmeadHospitalandUniversityofSydney •MasayukiKurosaki,DirectoroftheDepartmentofGastroenterologyandHepatology,MusashinoRedCrossHospital,Tokyo •JasminePwu,ChiefExecutiveOfficeroftheDataScienceCenter,Fu-JenCatholicUniversity,Taiwan •ShivKumarSarin,gastroenterologistandhepatologist;Chancellor,InstituteofLiverandBiliarySciences,NewDelhi;FormerChairmanoftheBoardofGovernors,MedicalCouncilofIndia •TawesakTanwandee,ProfessorandChiefoftheDivisionofGastroenterology,DepartmentofMedicine,FacultyofMedicine,SirirajHospital,MahidolUniversity,Bangkok •ManFungYuen,DeputyDepartmentChairpersonandChiefoftheDivisionofGastroenterologyandHepatology,UniversityofHongKong •QingXie,DirectorofDepartmentofInfectiousDisease,ShanghaiJiaotongUniversitySchoolofMedicine,RuijinHospital,Shanghai TheresearchteamforthisreportconsistsofNuriesyaSaleha,NeeladriVermaandJocelynHo.ThispaperwaswrittenbyJesseQuigleyJonesandeditedbyMariaRonald.ThefindingsandviewsexpressedinthisreportarethoseofEconomistImpactanddonotnecessarilyreflecttheviewsofthesponsor. Executivesummary Hepatocellularcarcinoma(HCC)isaleadingcauseofcancermortalityinAsia,anditsincidenceisexpectedtopeakwithinthenextdecade.ViralhepatitisBandCinfections aretheprimarydriversofHCCintheregion.However,metabolicdisorders,suchasnon-alcoholicliverdisease(NAFLD),diabetesandlifestyle-relatedriskfactorsaregrowingascontributorstotheHCCburden,reflectingchanginglifestylesanddemographics. GiventheavailabilityofhighlyeffectiveinterventionsforHCC,healthsystemsshouldprioritiseidentifyingHCCcasesearly.Thiswillfacilitateearlyintervention,andtherebyimprovepatientoutcomesand survival.Systematicsurveillanceprogrammesthatuseappropriatediagnostictoolstoidentifyat-riskpatientgroupsarethereforenecessarytomitigatetheimpactofHCC. SomeofthemostcomprehensiveHCCsurveillanceprogrammesarefoundinAsia.However,theirproliferationvarieswidelyacrosstheregion.Commonbarrierstoachievingcomprehensivesurveillanceprogrammesincludebuildingpoliticalwill,thecollectionanduseofepidemiologicalandreal-worlddata,adequatehumanandtechnologyresources,sustainablefinancing,andalackofpublicawarenessofthebenefitsofsurveillance. Learningfromthewell-establishedprogrammes,aswellasfromthechallengesidentified ineconomiesthathavenotimplementedsystematicHCCsurveillancethusfar,thisreporthighlightsseveralimportantpriorities: IncludeHCCsurveillanceinnationalprogrammesandstrategicplans. Wheretheburdenoflivercancerorunderlyingdisease(suchasviralhepatitisinfectionormetabolicdisease)ishigh,HCCsurveillanceandcontrolmustbeconsideredapublichealthpriority.HCCsurveillanceshouldbeincludedin nationalstrategicplanningwhereappropriate.Localincidenceandprevalenceofthedisease,aswellasexistingprioritiesandresources,shoulddictatewhereHCCsurveillancefitsintothenationalhealthstrategy.HCCmightbeincludedinstand-aloneHCCplans,viral hepatitiscontrolplansorbroadercancercontrolplans.Whentheseplansaresupportedbylegislationandfundingcommitments,countryexamplesshowHCCpatientsexperiencingbetteroutcomes.VaryinginstancesoftheincorporationofHCCsurveillanceinstrategicplansareseeninJapan,SouthKoreaandTaiwan. Securesustainablefundingcommitments. Inordertobesuccessful,programmesneedtoconsiderlong-termresourcingandfinancingforHCCsurveillance.Fundingdecisionsshouldbealignedwithevidence-basedclinicalguidelinesandbestpractices whereverpossible.Thismayrequireinvestinginadditionalultrasoundoradvancedimagingequipment,moreadvancedandoptimaltestingmodalities,trainedoperators,andlaboratorycapacity.Decision-makersshouldbeawarethatexpandingprogrammeswithoutconsideringtheadditionalcostsoftestingandresourcingplacesextrapressureonhealthsystems. TheappropriateleveloffundingforHCCsurveillanceisdictatedbyes