Hepatitis B a prime cause of liver cancer, says Ismail

NST: KUALA LUMPUR: A total of 2.5 million Malaysians have hepatitis, with the majority suffering from hepatitis B.
What is even more worrying is that six per cent of the population are also carriers of the disease.
Director-general of health Tan Sri Dr Ismail Merican said many of these people were not even aware that they were carriers.
Hepatitis B, he said, was 100 times more infectious than HIV.
It is a severe form of viral hepatitis largely transmitted through exposure to bodily fluids containing the virus. This includes through unprotected sexual contact, blood transfusions, re-use of contaminated needles and syringes, and from mother to child during childbirth.
Between one million and 1.5 million people in the world die each year of hepatitis B.
"If you are a hepatitis B carrier, you are 200 to 300 times more at risk of getting liver cancer," said Dr Ismail, who is also the president of the Malaysian Liver Foundation (MLF).
Globally, two billion people have been infected with hepatitis B. Of these, 25 to 40 per cent will die of cirrhosis of the liver or liver cancer. There are at least 350 million hepatitis B carriers worldwide and 75 per cent are Asians.
Eighty-two per cent of the world’s 530,000 cases of liver cancer per year are caused by viral hepatitis, 60 per cent of which is associated with hepatitis B and 22 per cent with hepatitis C.
Dr Ismail said the ministry and the MLF had repeatedly advised Malaysians to undergo hepatitis screening.
Those found to be suffering from the disease could be counselled and given treatment.
"Carriers are at risk of getting chronic liver disease and liver cancer. They need to be examined to see if they can be treated."
Dr Ismail said there were new modalities of treatment , especially for those suffering from hepatitis B and C.
With treatment, their risk of contracting chronic liver disease or liver cancer could be substantially lowered.
Liver cancer is one of the top five cancers among Malaysian males. The good news is that it can be prevented as the majority of liver cancer cases in the region are associated with hepatitis B, which has a vaccine for immunisation.
Sadly, though, almost 80 per cent of liver cancer patients only discover this too late.
"It is very sad to have to inform them that there is very little that can be done for them at that stage," said Dr Ismail. "It is especially tragic as the cancer could have been prevented had the patients been protected against hepatitis B.
"As such, those without immunity against hepatitis B should get themselves vaccinated."
Dr Ismail said the Government had been immunising infants against hepatitis B since 1989.
"This is why it is important that those born before 1989 go for screening as they are at a higher risk of getting liver cancer as a result of hepatitis B."
On recent Press reports that there was no guarantee that the hepatitis B vaccine was effective, Dr Ismail said it had been proved in many countries that vaccination could reduce the incidence of hepatitis B and, therefore, liver cancer.
He also said that there was no strong association between liver cancer and food or smoking. Alcohol plays a role to some extent as it can cause liver cirrhosis, which can then progress into liver cancer.
Dr Ismail said public forums on hepatitis were being held in all States to encourage people to undergo screening.
The MLF also organises "hepatitis days" where members of the public can undergo blood screening, vaccination and counselling. There are also seminars for doctors.
A total of 76 per cent of cirrhosis cases were hepatitis B-related, which is also responsible for 65 per cent to 70 per cent of hepatocellular carcinoma, a primary malignancy (cancer) of the liver.

Dr Ismail said many Malaysians were still confused over hepatitis A, B and C.
"If you are vaccinated against one type of hepatitis, it does not mean that you are protected against the others," he warned.
Hepatitis A is an infectious, food and water-borne disease which is especially common among children aged five to 14 years.
It is one of the world’s most common infectious diseases, being 10 to 100 times more common than typhoid and 1,000 times more common than cholera.
About 50 per cent of Malaysians below 30 years old do not have antibodies for hepatitis A and they are therefore susceptible to the disease, which could lead to acute liver failure, especially in older patients.
"Hepatitis A does not lead to chronic liver disease, but those who get it may suffer from serious morbidity for weeks and months which will affect their productivity."
Dr Ismail advised those without immunity against hepatitis A to get vaccinated as it would protect them against the disease for up to 10 years. There is a vaccine that offers protection against both hepatitis A and B.
Hepatitis C affects three per cent of the world’s population.
It is especially common among injecting drug addicts and those who undergo dialysis or transplants.
Up to 80 per cent of patients with hepatitis C will suffer from chronic hepatitis, which can lead to liver cancer.
There is no vaccine to prevent hepatitis C. Dr Ismail advised those who received blood transfusions before 1995 to get themselves tested for the disease.