Does neglect lead to liver cancer? Risks of Hepatitis CProfessor Kim Hwi-young, Department of Gastroenterology, University Mokdong Hospital

Where is hepatitis C transmitted?

 

Hepatitis C is spread by exposure to blood or bodily fluids. There are six main routes of infection:

 

*Vertical infection: Infection with a fungus or virus derived from the mother

 

In the case of vertical infection, the frequency varies between 1~6% depending on the study, but it is not a completely unprobable factor. In the case of tattoos, there are cases where the liquid itself is contaminated and infected even if disposable needles are used, and in the West, drug abusers often get infected while using syringes.

 

How common is hepatitis C?

 

The incidence of hepatitis C worldwide is 1~3%, and it is estimated that there are more than 100 million patients. It is especially common in Africa and Asia.

 

According to the World Health Organization (WHO), about 70% of cases of hepatitis C become chronic after becoming an acute infection. The problem is that about 20% of them develop cirrhosis such as cirrhosis, and 3~4% of patients develop liver cancer every year, leading to death. The tendency to become chronic is higher than that of hepatitis B, and the rate of progression from chronic hepatitis to cirrhosis and hepatocellular carcinoma is high.

 

Why is hepatitis C dangerous?

 

After the occurrence of chronic hepatitis C, it leads to cirrhosis and liver cancer 20~30 years later. It can be treated before cirrhosis occurs, but since it is usually asymptomatic, it does not receive proper treatment in time, leading to dangerous diseases. 33% of patients die within one year of liver cancer diagnosis, and the five-year survival rate for liver cancer is still rather low at 30%. Pancreatic cancer, gallbladder and otherbiliary tract, it is the second lowest scary carcinoma after lung cancer. In addition, the prognosis may be worse for the elderly, and liver cancer ranks first in mortality in the productive age of 40~50s, making liver cancer the No. 1 risk cancer in terms of socioeconomic burden.

 

Hepatitis C ranks third in cirrhosis after hepatitis B and other causes such as alcohol, and is the second leading cause of liver cancer after hepatitis B.

 

In addition, in a chronic hepatitis environment, it is the most common cause of liver cancer in the elderly population, and it is likely to become more of a problem in a rapidly aging society like Korea.

 

When acute hepatitis C occurs, the majority of patients develop chronic hepatitis C, except for the 20~25% that heal spontaneously. Chronic hepatitis C can lead to scary complications such as liver disease within 10~20 years.

 

Also, just as acne leaves scars due to inflammation, scars also leave on the liver. Through the process of inflammation and scarring, the area of the liver gradually shrinks and is replaced by scar tissue and scar tissue, causing the liver to become smaller and more lumpy, resulting in liver fibrosis. When the liver becomes fibrotic, it is unable to perform its essential functions in the body.

 

How is hepatitis C treated?

 

The treatment paradigm for hepatitis C has changed. About 20 years ago, it was reported that the combination of the injectable interferon* of the pediatric respiratory drug liavirin had a good therapeutic effect, and the combination of the two was the standard treatment. As time passed, an interferon generic drug called 'peginterferon' was introduced, and the cure rate increased to 60~70%. Finally, in 2015, a direct-action drug called DAA appeared. DAA has a high treatment effect of at least 65% and up to 99% with a treatment period of 8~12 weeks, and the patient can be well compliant with the treatment with the availability of medical insurance and easy treatment algorithm.

*Interferon: Antiviral Factor

 

In the case of hepatitis C, it is very difficult to develop a vaccine to prevent it, and although it is being researched steadily, it has not yet been commercialized. However, as mentioned above, treatment has advanced tremendously, and once it is found, the cure rate can be guaranteed.

 

The problem is that there are still many patients with hepatitis C who are hiding, even though the diagnosis rate needs to be high in order to proceed with treatment. According to WHO's statistics, more than 30,000 people should be diagnosed annually to eradicate hepatitis C by 2030, but the actual number of patients diagnosed annually is 6,000 to 10,000, and more than two-thirds of patients remain undiagnosed. The reason for this is that there are many cases where there are no symptoms even in the acute stage, and even in the case of chronic disease, most people do not know about it until it becomes severe.

 

Why is diagnosing hepatitis C important?

 

In the case of hepatitis C, early detection is important because, first, it can restore the patient's health through treatment, and second, it can reduce the chance of unknowingly transmitting it to others.

 

The diagnostic test consists of two steps:

 

First, primary screening test (antibody test)

It is a test in which blood is drawn and serum antibodies are used to indirectly measure infection.

 

Second, the second confirmatory test (detailed test)

The second confirmatory test will be conducted if there is a problem with the first screening. In addition, blood sampling is done to determine the presence and amount of virus.

 

In order to identify a large number of potential patients, in 2020, the Korea Centers for Disease Control and Prevention conducted a free hepatitis C screening for people born in 1964. When we analyzed the data of the liver cancer registry project in Korea in 2008~2014, 97% of them were older than those born in 1964, so it was judged to be the most cost-effective age. It can be said that this project was to prepare evidence to find out how effective early detection of hepatitis C is through national screening for all adults.

 

With the expected effect of national testing for hepatitis C, in the short term, it will be possible to prevent new infections by blocking the transmission of the virus through asymptomatic infected people. In the long term, it will prevent cirrhosis and liver cancer caused by hepatitis C, reducing the serious social costs of health care and premature death.

 

In developed countries such as the United States, mass screening for hepatitis C has been found to be cost-effective, no matter how low the prevalence is, and it is recommended that all people over the age of 18 be screened for hepatitis C once in their lifetime. In addition, in Egypt in 2020, state-sponsored low-cost hepatitis C screening reduced new infections by 1/10.

 

In the past, it was an incurable disease, but now it can be easily treated with oral medicine. Preemptive detection and early treatment can prevent liver cancer from developing, so people who are at high risk should be screened as soon as possible. Also, even if you don't have symptoms, if you think you may be at risk, you should get tested.