Towards eliminating hepatocellular carcinoma from Aotearoa New Zealand: a nationally coordinated programme to detect and treat chronic hepatitis?

Hepatocellular carcinoma (HCC) is the seventh most common cancer globally, with 1 million people diagnosed and 830,000 cancer-related deaths annually, demonstrating the paucity of effective treatments, particularly for late-stage disease. Globally, and in Aotearoa New Zealand (AoNZ), chronic infection with hepatitis B (Hep-B) or hepatitis C (Hep-C) remain the most significant aetiological factors and the most amenable to intervention. Whilst Hep-B vaccination was nationally implemented in AoNZ in 1988 in children up to the age of 15 years, an estimated 3.2 million New Zealanders remain unvaccinated, each with up to a 15% likelihood of developing HCC by the age of 70 years if they contract Hep-B during their lifetime. Overall, 19,000 Māori, 15,000 Pacific and 10,000 non-Māori and non-Pacific New Zealanders are affected with undiagnosed Hep-B. Correspondingly, 45,000 New Zealanders are infected with chronic Hep-C with an appreciable long-term risk of developing HCC. Inexplicably, there has never been a nationally coordinated screening, treatment and surveillance programme established for either condition. An appropriately resourced, community-based programme to detect and treat Hep-B and Hep-C and screen for HCC in high-risk individuals, as well as optimising Hep-B vaccination rates, must be a national health priority.