Hepatocellular carcinoma in Australia's Northern Territory: high incidence and poor outcome

Abstract

HCC incidence remains high in the Indigenous people of the NT. More resources are needed for HCC surveillance and management programs in this population.

Author reply

“…We do not have enough information to recommend different starting points based on gender, like we currently do for Asians . That 40% of the HCC occurred in indigenous women suggests this would be unwise too . Possibly, recommendations for Africans for screening to commence at age 20 should apply.…”

“…for their letter providing readers with useful additional insights about chronic hepatitis B virus (HBV) infection in the Aboriginal and Torres Strait Islander People for our article ‘Hepatitis A to E: what's new’ . It was an oversight not to include comment on this important population, whose needs have been critically highlighted in the recent article by Parker et al ., which describes the relatively high incidence and poor outcome of hepatocellular cancer (HCC) in indigenous people of the Northern Territory . Indigenous Australians tend to present late and outside of surveillance programmes with individual annual HCC risk, in HBV‐infected indigenous people, 0.34% for ages 50–59 and 0.83% for ages 60–69.…”

Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia

“…Many are unaware of their diagnosis as there are suboptimal screening rates . Increased rates of testing are urgently required due to the association of hepatitis B with cirrhosis and hepatocellular carcinoma, while liver disease is among the top three diseases contributing to the reduced life expectancy of Indigenous Australians compared to non‐Indigenous Australians…”

The unique aspects of chronic hepatitis B infection in Aboriginal and Torres Strait Islander people

“…Indigenous Australians make up 2.5% of the national population but comprise 9.3% of those with CHB . Their risk of hepatocellular carcinoma (HCC) is six times that of the non‐indigenous population and contemporary estimates of HBsAg positivity for Indigenous Australians in the Northern Territory (NT) are 6.08% . Uniquely, all Indigenous Australians living with CHB in the NT whose virus has been molecularly examined have been shown to have the otherwise uncommon sub‐genotype C4 .…”

“…Based on this demonstrated high risk of HCC, in collaboration with the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) and the Central Australian Rural Practitioners Association, we have adapted the HCC screening table from the American Association for the Study of Liver Disease guidelines that was presented in Mohsen and Levy's review to include Indigenous Australians over the age of 50 (Fig. ).…”