It's time to change course on liver disease
by Dr. Eric Yoshida, Chairman, Canadian Liver Foundation Medical Advisory Committee
Only 10 per cent of an iceberg can be seen above the water. When the Titanic hit an iceberg in 1912, it wasn’t the part above the water that did all the damage – it was the 90 per cent that lurked below the surface that ultimately sank the ship.
Recently Statistics Canada released a report on cancer prevalence in Canada that showed that liver cancer has increased 8.5 per cent in the past ten years (more than double the rate of any other cancer except thyroid) with an annual increase of 6.1 per cent among women and 9.1 per cent in men. These statistics are what might be described as the ‘tip of the iceberg’ for liver disease in Canada. What we should be most concerned about is what the statistics do not show.
The majority of liver cancer cases are the result of underlying – and often undiagnosed – conditions. The leading causes of liver cancer are hepatitis B and hepatitis C, but cirrhosis can be from any cause, including non-alcoholic fatty liver disease, which is now very common in Canada. An estimated 600,000 Canadians are living with chronic hepatitis B or C and as many as 1.4 million have fatty liver disease. These are not fast moving diseases and the transformation to cancer takes many years to decades. This is more than enough time to sound the alarm and do something to prevent more people from suffering a personal tragedy. There are many reasons for the increasing rate of cancer but the fact is that individual Canadians, government agencies and the medical community/health care community must be expected to do more in the future.
The keys to reducing these liver cancer rates are early diagnosis of the underlying liver disease, effective treatment, screening for liver cancer in those at increased risk and active medical research. Today we have antiviral therapies that can effectively treat the majority of hepatitis B and hepatitis C. Unfortunately, these treatments are not yet accessible to everyone who needs them.
Last November, the Canadian Association for the Study of the Liver (CASL) which represents the liver specialists of Canada, held its fifth viral hepatitis consensus meeting since 1994. The proceedings of this meeting will be published with updated clinical guidelines for treating hepatitis B and C. These guidelines will advise the use of drug therapies which are licensed for use in Canada and commercially available but may not currently be part of the provincial formularies and therefore not eligible for patient reimbursement (or eligible only under restrictive criteria). Once the new guidelines are published and freely available to healthcare professionals and patients alike, the CLF will be working with CASL to encourage the provinces to adopt the new Canadian recommendations and revise their policies to the benefit of the many Canadians with viral hepatitis.
Like an iceberg, much about liver cancer remains hidden. Researchers are studying it from all aspects but as yet we still do not understand enough about how liver cancer and other forms of liver disease develop, how they might be prevented and, of course, effective therapies are needed. As you will see in our Good News section, the CLF has committed $1 million to liver research for 2012. These funds will allow Canadian researchers to conduct studies in liver cancer, pediatric liver disease and other forms of liver disease. Improving the current situation can only come about via good research and the research funded by the CLF will help provide answers and hope for the future.
In the meantime, we can all play an effective role in preventing liver cancer or ensuring it is detected at an early stage. Since March is Liver Health Month, the CLF encourages you to take charge of your liver health by following these steps:
1. Get vaccinated against hepatitis A and B.
2. Ask your doctor to include liver tests as part of your annual health assessment and screen you for viral hepatitis.
3. If you have hepatitis B or C, ask your doctor about treatment and regular liver cancer screening.
4. Adopt a healthy diet with vegetables, fruit and lots of fibre. Avoid excess table sugar, high fat and high calorie foods.
5. Get regular exercise
6. If you drink alcohol, do not drink more than one to two drinks per occasion and do not drink everyday. If you have liver disease, avoid alcohol completely.
Liver cancer may be on the horizon but with decisive action by all concerned we can avoid a collision course. Death from liver cancer should be preventable. Let’s make it a thing of the past.
Only 10 per cent of an iceberg can be seen above the water. When the Titanic hit an iceberg in 1912, it wasn’t the part above the water that did all the damage – it was the 90 per cent that lurked below the surface that ultimately sank the ship.
Recently Statistics Canada released a report on cancer prevalence in Canada that showed that liver cancer has increased 8.5 per cent in the past ten years (more than double the rate of any other cancer except thyroid) with an annual increase of 6.1 per cent among women and 9.1 per cent in men. These statistics are what might be described as the ‘tip of the iceberg’ for liver disease in Canada. What we should be most concerned about is what the statistics do not show.
The majority of liver cancer cases are the result of underlying – and often undiagnosed – conditions. The leading causes of liver cancer are hepatitis B and hepatitis C, but cirrhosis can be from any cause, including non-alcoholic fatty liver disease, which is now very common in Canada. An estimated 600,000 Canadians are living with chronic hepatitis B or C and as many as 1.4 million have fatty liver disease. These are not fast moving diseases and the transformation to cancer takes many years to decades. This is more than enough time to sound the alarm and do something to prevent more people from suffering a personal tragedy. There are many reasons for the increasing rate of cancer but the fact is that individual Canadians, government agencies and the medical community/health care community must be expected to do more in the future.
The keys to reducing these liver cancer rates are early diagnosis of the underlying liver disease, effective treatment, screening for liver cancer in those at increased risk and active medical research. Today we have antiviral therapies that can effectively treat the majority of hepatitis B and hepatitis C. Unfortunately, these treatments are not yet accessible to everyone who needs them.
Last November, the Canadian Association for the Study of the Liver (CASL) which represents the liver specialists of Canada, held its fifth viral hepatitis consensus meeting since 1994. The proceedings of this meeting will be published with updated clinical guidelines for treating hepatitis B and C. These guidelines will advise the use of drug therapies which are licensed for use in Canada and commercially available but may not currently be part of the provincial formularies and therefore not eligible for patient reimbursement (or eligible only under restrictive criteria). Once the new guidelines are published and freely available to healthcare professionals and patients alike, the CLF will be working with CASL to encourage the provinces to adopt the new Canadian recommendations and revise their policies to the benefit of the many Canadians with viral hepatitis.
Like an iceberg, much about liver cancer remains hidden. Researchers are studying it from all aspects but as yet we still do not understand enough about how liver cancer and other forms of liver disease develop, how they might be prevented and, of course, effective therapies are needed. As you will see in our Good News section, the CLF has committed $1 million to liver research for 2012. These funds will allow Canadian researchers to conduct studies in liver cancer, pediatric liver disease and other forms of liver disease. Improving the current situation can only come about via good research and the research funded by the CLF will help provide answers and hope for the future.
In the meantime, we can all play an effective role in preventing liver cancer or ensuring it is detected at an early stage. Since March is Liver Health Month, the CLF encourages you to take charge of your liver health by following these steps:
1. Get vaccinated against hepatitis A and B.
2. Ask your doctor to include liver tests as part of your annual health assessment and screen you for viral hepatitis.
3. If you have hepatitis B or C, ask your doctor about treatment and regular liver cancer screening.
4. Adopt a healthy diet with vegetables, fruit and lots of fibre. Avoid excess table sugar, high fat and high calorie foods.
5. Get regular exercise
6. If you drink alcohol, do not drink more than one to two drinks per occasion and do not drink everyday. If you have liver disease, avoid alcohol completely.
Liver cancer may be on the horizon but with decisive action by all concerned we can avoid a collision course. Death from liver cancer should be preventable. Let’s make it a thing of the past.
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