Leading physicians are calling for radical improvements in dealing with the hepatitis epidemics in Australia and New Zealand to control the big increase in the number of liver cancer cases.
The Australasian Viral Hepatitis Conference being held in Auckland this week will issue a statement today urging governments and health authorities to commit to doubling the number of hepatitis B and C patients receiving treatment and doing more to reduce the number of people who contract viral hepatitis.
Hepatitis B and C are the leading causes of liver cancer.
"Liver cancer is a terrible disease," said Professor Ed Gane, deputy director of the New Zealand Liver Transplant Unit at Auckland City Hospital.
"In most patients it presents late with very little in the way of therapeutic options and very short survival."
The median survival time of liver cancer patients was less than one year following diagnosis, he said.
There had been an "exponential increase" in the number of liver cancer cases in the upper North Island - "a five-fold increase in the last 10 to 15 years" - and this had increased the demand for liver transplants, one of the most successful treatments.
The demand for donated livers outstrips supply and about 10 per cent of people who are placed on the waiting list for a donated liver in Australia or New Zealand will die before they receive one.
Australian infectious diseases physician Dr Ben Cowie said it was important to increase the number of people receiving treatment for hepatitis B and C because treatment "can prevent these cancers".
"Despite the evidence that treatment does prevent liver cancer in a cost-effective fashion, treatment access is extremely poor in Australia and New Zealand."
"We need to save lives from a disease that is largely preventable."
The low hepatitis treatment rates are linked to the stigma and discrimination associated with the diseases, many people not knowing they are infected, fears of the side effects of treatment and long waiting times at some hospitals.
Professor Gane said hepatitis B and C patients referred to a metropolitan New Zealand hospital could expect to wait for three to six months to be seen, and up to a year or more in a smaller regional hospital.
Dr Cowie said hepatitis B or C patients with undiagnosed liver damage who had to wait a year to be seen faced a 2 to 3 per cent chance of acquiring liver cancer while they waited.
"From a human rights perspective I think that's unacceptable in rich societies like Australia and New Zealand."
The Hepatitis Foundation has been contracted by health authorities to run pilot hepatitis C programmes in the Bay of Plenty and in the Wellington-Wairarapa region. They will provide community education and aim to identify undiagnosed cases of the disease. The foundation hopes that after their pilot phase, which runs for two years, the programmes will become national.
NEW DRUG GETS ACTRESS' BACKING
Rena Owen will champion a new drug which has cured her of hepatitis C when she attends the Australasian Viral Hepatitis Conference in Auckland today.
The Once Were Warriors actress wasn't available to speak yesterday about the circumstances around how she contracted the virus, but in an interview in this week's New Zealand Woman's Weekly she said she wanted to "help reduce stigma, encourage those at risk to get tested and, if positive, to get treated".
Hepatitis C can be contracted by infected blood and the Hepatitis Foundation says the most common method of transmission is by sharing intravenous drug-taking equipment.
However, non-sterile tattoo and body piercing equipment can also pass on the virus.
Owen called hepatitis C a "silent killer".
"Anywhere there's blood you've got to be careful. It's not going away. Look at the tattooing and piercing. It's more prevalent than ever. And the botox - everyone is nipping into five-minute botox clinics."
The foundation estimates 75 per cent of those infected don't know they are living with the disease.
Owen said her speaking out was part of a well-worn path: "The line, 'If telling my story saves one life, why keep it a secret?' is very appropriate and powerful."
How many people have hepatitis in New Zealand?
An estimated 50,000 people have hepatitis C and 90,000 have hepatitis B. Most people who have been infected with either of the viruses don't know they have it.
How do you catch the infections?
Hepatitis B is transmitted by infected body fluids, including blood. It can be spread sexually, from an infected mother to her child during birth, and through abrasions. A vaccination is available on the childhood schedule.
Hepatitis C is spread by infected blood, including by injecting drug users sharing equipment, needlestick injuries to health workers, during childbirth and historically by infected blood transfusions. Non-sterile tattooing and body-piercing equipment are also potential sources. There is no vaccine.
What health effects do the viruses have?
Most people who get hepatitis B will clear the virus without any illness, some will get an acute illness then clear the virus, while others become long-term carriers. It is estimated that 20 per cent of people who get chronic hepatitis C will clear the virus, but in the rest, the virus slowly attacks the liver, leading to progressive liver damage, failure or cancer.
How many patients are treated?
One to 2 per cent of the estimated 50,000 with hepatitis C and around 5 per cent of the 90,000 with hepatitis B.
How effective is the treatment?
Drugs for hepatitis B are effective but resistance can develop and some cause side effects. Hepatitis C drug cure rates range from 55 per cent to 80 per cent and new, improved drugs are available but not yet subsidised.
What is the liver cancer death rate?
In 2009, liver cancer killed 208 people, up from 148 in 2003.
Why is the conference calling for action on hepatitis now?
Experts say a big push is needed in prevention and treatment to halt the escalation of deaths from liver cancer.