Dr jojo go hep b liver ca summit

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Dr. John Julliard Go …

Dr. John Julliard Go
National Professional Officer for NCDs
World Health Organization WPRO

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  • Approximately 1 000 000 people die each year (~2.7% of all deaths) from causes related to viral hepatitis, most commonly liver disease, including liver cancer.
    An estimated 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer
  • According to the Global Burden of Disease estimates, hepatitis B and hepatitis C together caused 1.4 million deaths in 2010, including deaths from acute infection, liver cancer and cirrhosis.
  • Approximately 1 000 000 people die each year (~2.7% of all deaths) from causes related to viral hepatitis, most commonly liver disease, including liver cancer.
    An estimated 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer
  • The likelihood that infection with the hepatitis B virus becomes chronic depends upon the age at which a person becomes infected.
    Children less than 6 years of age who become infected with the hepatitis B virus are the most likely to develop chronic infections:
    80–90% of infants infected during the first year of life develop chronic infections;
    30–50%% of children infected before the age of 6 years develop chronic infections.
    In adults:
    <5% of otherwise healthy adults who are infected will develop chronic infection;
    15–25% of adults who become chronically infected during childhood die from hepatitis B-related liver cancer or cirrhosis.
  • Liver cancer is largely a problem of the less developed regions where 83% (50% in China alone) of the estimated 782,000 new cancer cases worldwide occurred in 2012. It is the fifth most common cancer in men (554,000 cases, 7.5% of the total) and the ninth in women (228,000 cases, 3.4%).
  • In men, the regions of high incidence are Eastern and South-Eastern Asia (ASRs 31.9 and 22.2 respectively). In women, the rates are generally much lower, the highest being in Eastern Asia and Western Africa (10.2 and 8.1 respectively).
    Liver cancer estimated to be responsible for nearly 746,000 deaths in 2012 (9.1% of the total).
    The prognosis for liver cancer is very poor (overall ratio of mortality to incidence of 0.95), and as such the geographical patterns in incidence and mortality are similar.
  • Liver cancer is the 6th most common cancer in 2012, and third most common cause of death from cancer worldwide in both sexes.
  • Among men, liver cancer is the 5th most common cancer, and second most common cause of death from cancer. (5 and 2)
  • Among women, liver cancer is the 9th most common cancer, and sixth most common cause of death from cancer. (9 and 6)
  • 6 and 3
  • 3 and 2 among men (PHL)
  • 5 and 4
  • In 2010, the World Health Assembly adopted its first resolution on viral hepatitis and called for a comprehensive approach to prevention and control, opened a new era of awareness about the magnitude of the disease and the need for urgent action on several fronts.
  • The World Health Organization (WHO) followed up on the resolution in 2012 by crafting a strategy that addresses four axes: awareness-raising, partnerships and resource mobilization; evidence-based policy and data for action; prevention of transmission; and screening, care and treatment.
  • To raise awareness about hepatitis
  • WHO Member States at the 58th World Health Assembly in Geneva approved a resolution on Cancer Prevention and Control which called on all Member States to develop national cancer programmes, to cover strategies on prevention, early detection, diagnosis and treatment, and palliative care.
    The global cancer control strategy encouraged national governments to provide the unifying framework so actions at all levels and by all stakeholders will be mutually supportive.
    It emphasized the need for multisectoral action as many cancer risk factors lie outside the health sector’s direct influence.
    It pushed for integrated interventions and seeks involvement of governments and nongovernmental organizations, like health professional associations and national cancer societies.
  • WHO also addresses some of the main risk factors for NCDs through global action, such as the Framework Convention on Tobacco Control and the Global Strategy on Diet, Physical Activity, and Health.
  • WHO also addresses some of the main risk factors for cardiovascular disease through global action, such as the Framework Convention on Tobacco Control and the Global Strategy on Diet, Physical Activity, and Health.
  • WHO also addresses some of the main risk factors for cardiovascular disease through global action, such as the Framework Convention on Tobacco Control and the Global Strategy on Diet, Physical Activity, and Health.
  • There were 14.1 million new cancer cases, 8.2 million cancer deaths and 32.6 million people living with cancer (within 5 years of diagnosis) in 2012 worldwide. 57% (8 million) of new cancer cases, 65% (5.3 million) of the cancer deaths and 48% (15.6 million) of the 5-year prevalent cancer cases occurred in the less developed regions.
    The overall age standardized cancer incidence rate is almost 25% higher in men than in women, with rates of 205 and 165 per 100,000, respectively.

Transcript

  • 1. Global Burden of Hepatitis and Liver Cancer Philippine Hepatitis and Liver Cancer Summit 2014 Shangrila Hotel, Makati City 4 February 2014 Office of the WHO Representative in the Philippines
  • 2. Noncommunicable Diseases (NCDs) • Heart diseases and strokes • Cancers • Diabetes • Chronic respiratory diseases 36M deaths each year due to NCDs… Office of the WHO Representative in the Philippines
  • 3. Global Burden of Cancer • Cancer is the world’s second biggest killer after cardiovascular diseases. • It kills around 8.2 million people globally each year. 65% (5.3 million) of the cancer deaths occurred in les developed regions, with huge implications on human suffering, health systems, health budgets, and efforts to reduce poverty. Office of the WHO Representative in the Philippines
  • 4. Viral Hepatitis • Viral hepatitis is a group of infectious diseases that affects hundreds of millions of people worldwide. • Five distinct hepatitis viruses have been identified: A, B, C, D and E. • Hepatitis B and C are particularly prevalent. • Untreated chronic hepatitis B and C infection can result in liver cirrhosis and liver cancer. • An estimated 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer result from HBV or HCV infection. Office of the WHO Representative in the Philippines
  • 5. Global Burden of hepatitis B (HBV) and hepatitis C (HCV) • 500 million chronically infected – 350 million HBV – 150-170 million HCV • 1 million deaths per year – 600,000 HBV – 350,000 HCV • 57% of cirrhosis – 30% HBV – 27% HCV • 78% of Hepatocellular carcinoma – 53% HBV – 25% HCV
  • 6. Number of hepatitis deaths, 2010
  • 7. Chronic Hepatitis B Infection • Children less than 6 years of age who become infected with the hepatitis B virus are the most likely to develop chronic infections. • 80–90% of infants infected during the first year of life develop chronic infections. • 30–50%% of children infected before the age of 6 years develop chronic infections. • In adults: <5% of otherwise healthy adults who are infected will develop chronic infection; • 15–25% of adults who become chronically infected during childhood die from hepatitis B-related liver cancer or cirrhosis. Office of the WHO Representative in the Philippines
  • 8. Hepatitis B and C in Philippines • Estimated 7.3 M (16.7% of adult population) chronically infected with BHV • Around 2.3% or 1 M Filipinos may be infected with HCV » Source: Hepatology Society of thePhilippines, 2013 Office of the WHO Representative in the Philippines
  • 9. Why should we be concerned about viral hepatitis? • Millions of people are living with viral hepatitis and millions more are at risk. • Most people who were infected long ago with HBV or HCV are unaware of their chronic infection. They are at high risk of developing severe chronic liver disease and can unknowingly transmit the infection to other people. • Viral hepatitis places a heavy burden on the health care system because of the costs of treatment of liver failure and chronic liver disease. • Some groups are at more risk of contracting viral hepatitis than others. Office of the WHO Representative in the Philippines
  • 10. Liver Cancer Estimated Incidence, Mortality and Prevalence Worldwide in 2012 Office of the WHO Representative in the Philippines
  • 11. Office of the WHO Representative in the Philippines
  • 12. Office of the WHO Representative in the Philippines
  • 13. Office of the WHO Representative in the Philippines
  • 14. Office of the WHO Representative in the Philippines
  • 15. Office of the WHO Representative in the Philippines
  • 16. Office of the WHO Representative in the Philippines
  • 17. Office of the WHO Representative in the Philippines
  • 18. Risk Factors for Liver Cancer • • • • • • • • • Chronic Viral Hepatitis B and C – most common risk factor Cirrhosis Heavy alcohol use Aflatoxin Obesity Type 2 Diabetes Tobacco Use Gender: Male Race/ Ethnicity Office of the WHO Representative in the Philippines
  • 19. • 2010 World Health Assembly resolution 63.18: – Call for comprehensive approach to hepatitis prevention and control • Mandate to WHO: – Develop guidelines and strategies for surveillance, prevention and control of viral hepatitis – Support development of scientific research – Improve global prevalence and disease-burden estimates – Mobilize support – Strengthen WHO Safe Injection Global Network
  • 20. Framework for global action • Vision: – A world where viral hepatitis transmission is stopped and all have access to safe and effective care and treatment. • Axes: – Axis 1: Raising awareness, promoting partnerships and mobilizing resources – Axis 2: Evidence-based policy and data for action – Axis 3: Prevention of transmission – Axis 4: Care and Treatment
  • 21. Monitoring the Response: the 2012 Survey • Baseline survey • Provided information relating to the four axes of he WHO strategy • Will be carried out every one to two years to monitor overall progress in implementation Office of the WHO Representative in the Philippines
  • 22. WHO Regional Goals to prevent HepB through VACCINATION 2003: the WHO Region agreed to set targets for HepB control though vaccination 2005: the Region adopted targets:  Milestone: reduce chronic HB prevalence to <2% in children at least 5 years old by 2012  Goal: <1% prevalence, target year to established 2013: the Region decided the <1% prevalence target as 2017
  • 23. World Hepatitis Day (28 July) Office of the WHO Representative in the Philippines
  • 24. How WHO Fights Cancer • Backed by the World Health Assembly resolution 58.22 of 2005 on cancer prevention and control, WHO is committed to a Global Action Plan Against Cancer to reduce the cancer burden worldwide. Office of the WHO Representative in the Philippines
  • 25. The WHO Global NCD Action Plan 2013-2020 Vision: A world free of the avoidable burden of NCDs Goal: To reduce the preventable and avoidable burden of morbidity, mortality and disability due to NCDs by means of multisectoral collaboration and cooperation at national, regional and global levels
  • 26. WHO Framework Convention on Tobacco Control (FCTC) Quitting tobacco is the best way to reduce cancer. To help make this happen, WHO develops and helps implement powerful tobacco controls. Office of the WHO Representative in the Philippines
  • 27. WHO Global Strategy on Diet, Physical Activity and Health • Eating well and staying active are keys to leading healthier lives and eliminating the risks of chronic conditions like cancer. • WHO works with countries to craft straightforward approaches to promote healthy diets and physical activity. Office of the WHO Representative in the Philippines
  • 28. Global Strategy on Harmful Use of Alcohol •WHO works with governments to introduce policies that reduce the negative health consequences of hazardous and harmful alcohol use, identify risky drinking patterns and improve public health. • In 2005, the World Health Assembly adopted a resolution on “public health problems caused by harmful use of alcohol,” urging countries to develop, implement and evaluate effective strategies to reduce the health and social problems associated with alcohol. Office of the WHO Representative in the Philippines
  • 29. Immunization Drives Against Hepatitis B • WHO promotes the introduction of hepatitis B vaccine in many poor countries. • WHO estimates more than 2 million child deaths were averted through immunization in 2003, plus another 600 000 hepatitis Brelated deaths that would have occurred in adulthood from liver cancer and cirrhosis. Office of the WHO Representative in the Philippines
  • 30. NCD “best buys” Condition Interventions Tobacco use Tax increases; smoke-free indoor workplaces & public places; health information / warnings; advertising/promotion bans Alcohol use Tax increases; restrict retail access; advertising bans Unhealthy diet & physical inactivity Reduced salt intake; replacement of trans fat; public awareness about diet & physical activity CVD & diabetes Counselling & multi-drug therapy (including glycaemic control for diabetes) for people with >30% CVD risk (including those with CVD); treatment of heart attacks with aspirin Cancer Hepatitis B immunization to prevent liver cancer; screening & treatment of pre-cancerous lesions to prevent cervical cancer
  • 31. Office of the WHO Representative in the Philippines
  • 32. Office of the WHO Representative in the Philippines
  • 33. Office of the WHO Representative in the Philippines
  • 34. Thank you Office of the WHO Representative in the Philippines
  • 35. Population-wide Interventions: on Cancer Prevention • Vaccination against Hepatitis (BEST BUY) • HPV vaccination • Protection against environmental or occupational risk factors for cancer, such as aflatoxin, asbestos and contaminants in drinking-water • Screening for breast and cervical cancer Office of the WHO Representative in the Philippines
  • 36. Office of the WHO Representative in the Philippines
  • 37. Office of the WHO Representative in the Philippines