08 Mar 2023
Missed opportunities for early diagnosis of viral hepatitis lead to high numbers of preventable deaths
While hepatitis B or C can be effectively managed with antiviral treatments when detected early, a late diagnosis can lead to poor health outcomes and higher risks of liver cancer (hepatocellular carcinoma, HCC) - the third leading cause of cancer-related deaths worldwide. In fact, hundreds of preventable deaths due to viral hepatitis continue to occur in Australia each year.¹
This is hard to imagine with treatment for hepatitis B and hepatitis C so broadly available in Australia. But barriers to care still exist. To access treatment, individuals living with chronic viral hepatitis must first be diagnosed.
In a study published in the Journal of Gastroenterology and Hepatology, researchers from the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute examined the impact of late diagnosis of viral hepatitis in relation to subsequent diagnosis with liver cancer over time in Victoria, Australia.
The prevalence of late diagnosis of viral hepatitis for people with liver cancer is high. The research shows that, between 1997 and 2014, among people diagnosed with liver cancer and viral hepatitis half received a late diagnosis of hepatitis B and one in three received a late diagnosis of hepatitis C.
The study also looked at how often these people accessed health services before their diagnosis of liver cancer. While it has been proposed that late diagnosis of viral hepatitis may be explained by low health care access in general, this research has found that most individuals diagnosed late had extensive health system contact in the 10 years prior to their liver cancer diagnosis.
In fact, 95 per cent of those diagnosed late with hepatitis B or C had visited a GP and 89 per cent had a blood test with an average of over two healthcare visits per year during the decade prior to late diagnosis.
The Royal Melbourne Hospital’s Jennifer MacLachlan is a Senior Epidemiologist with the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute and corresponding author on the paper.
“Our study is unique in that it highlights how many doctor's appointments and blood tests occurred in the 10 years before the late diagnosis. And what we’ve found is that many people who received a late diagnosis of viral hepatitis have had frequent interactions with healthcare services before their diagnosis,” Ms MacLachlan explains.
“This suggests that opportunities for timely detection of viral hepatitis and early intervention may have been missed.”
The Royal Melbourne Hospital’s Professor Benjamin Cowie, Director of the WHO Collaborating Centre for Viral Hepatitis at the Doherty Institute and senior author of the paper, says that these missed opportunities for early detection of viral hepatitis and subsequent late diagnosis are a concern.
“Early diagnosis of viral hepatitis is critical because it enables timely access to antiviral treatments that are highly effective at reducing progression to cirrhosis and the incidence of liver cancer,” Professor Cowie says.
“The proportion of people receiving a late diagnosis is unacceptably high. We must urgently prioritise public health strategies to increase timely detection, improve linkage to care, and reduce preventable deaths, in line with the goal of eliminating viral hepatitis as a public health concern by 2030, a goal endorsed by Australia and all other member states of the World Health Organization.”
The WHO Collaborating Centre for Viral Hepatitis leads a study called HepLOGIC, looking to improve the identification and care of people at risk of hepatitis B and C, and ultimately liver cancer, in general practice. Central to the project is a pilot and feasibility study to test a digital clinical decision-support system that uses data from general practice records to prompt risk-based testing and support the clinical care of people living with chronic viral hepatitis.
Peer review: Journal of Gastroenterology and Hepatology https://doi.org/10.1111/jgh.16162
Funding: Royal Melbourne Hospital Foundation Research Project Grant
¹ Nguyen A, Romero N, MacLachlan JH, Cowie BC. National Surveillance for Hepatitis B Indicators: Measuring the progress towards the targets of the National Hepatitis B Strategy –Annual Report 2021. Melbourne: WHO Collaborating Centre for Viral Hepatitis, The Doherty Institute, 2022