title: Hepatitis-Associated Liver Cancer: Gaps and Opportunities to Improve Care.
abstract: The global burden of hepatocellular carcinoma (HCC; primary liver cancer) is increasing. HCC is often unaccompanied by clear symptomatology, causing patients to be unaware of their disease. Moreover, effective treatment for those with advanced disease is lacking. As such, effective surveillance and early detection of HCC are essential. However, current screening and surveillance guidelines are not being fully implemented. Some at-risk populations fall outside of the guidelines, and patients who are screened are often not diagnosed at an early enough stage for treatment to be effective. From March 17 to 19, 2015, the Hepatitis B Foundation sponsored a workshop to identify gaps and limitations in current approaches to the detection and treatment of HCC and to define research priorities and opportunities for advocacy. In this Commentary, we summarize areas for further research and action that were discussed throughout the workshop to improve the recognition of liver disease generally, improve the recognition of liver cancer risk, and improve the recognition that screening for HCC makes a life-saving difference. Participants agreed that primary prevention of HCC relies on prevention and treatment of viral hepatitis and other underlying etiologies. Earlier diagnosis (secondary prevention) needs to be substantially improved. Areas for attention include increasing practitioner awareness, better definition of at-risk populations, and improved performance of screening approaches (ultrasound, biomarkers for detection, risk stratification, targeted therapies). The heterogeneous nature of HCC makes it unlikely that a single therapeutic agent will be universally effective. Medical management will benefit from the development of new, targeted treatment approaches.
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS).
authors.forename: Brian
authors.initials: B
authors.lastname: McMahon
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS). joan.block@hepb.org.
authors.forename: Joan
authors.initials: J
authors.lastname: Block
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS).
authors.forename: Timothy
authors.initials: T
authors.lastname: Block
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS).
authors.forename: Chari
authors.initials: C
authors.lastname: Cohen
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS).
authors.forename: Alison A
authors.initials: AA
authors.lastname: Evans
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS).
authors.forename: Anu
authors.initials: A
authors.lastname: Hosangadi
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS).
authors.forename: W Thomas
authors.initials: WT
authors.lastname: London
authors.affiliation: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK (BM); Hepatitis B Foundation, Doylestown, PA (JB); Baruch S. Blumberg Institute and Hepatitis B Foundation, Doylestown, PA (TB); Hepatitis B Foundation, Doylestown, PA (CC); Drexel University School of Public Health, Philadelphia, PA (AAE); Hepatitis B Foundation, Doylestown, PA (AH); Fox Chase Cancer Center, Philadelphia, PA (WTL); University of Toronto, Toronto, Canada (MS).
authors.forename: Morris
authors.initials: M
authors.lastname: Sherman
mesh_terms: D014408:Biomarkers, Tumor / Q000378:metabolism*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000378:metabolism / Q000517:prevention & control* / Q000821:virology; D055088:Early Detection of Cancer; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000517:prevention & control* / Q000821:virology; D009367:Neoplasm Staging; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications; D011159:Population Surveillance / Q000379:methods; D011322:Primary Prevention / Q000379:methods
chemical_list: D014408:Biomarkers, Tumor