Samuel So, MBBS, FACS
Lui Hac Minh Professor
Professor of Surgery
Director, Asian Liver Center
Stanford University School ...
Liver Cancer
7th most common cancer in the world
Ranks 2nd in causing the most cancer deaths

each year (746,000 deaths ...
Western Pacific Region has the Greatest
Burden of Liver Cancer in the World

WPRO accounts for
66% of new liver cancer
cas...
Top 5 Causes of Cancer Deaths
in the Philippines
Men

Women

Both Sexes

1
2

Lung

Liver

Breast
Cervix

Lung
Breast

3

...
Liver cancer deaths
will double in 20 yrs

GLOBOCAN 2012 (IARC)
Liver Cancer is A Leading Cause of Cancer Death in
Countries where Chronic Hepatitis B is Prevalent

Thailand
Vietnam
Chin...
Transmission of HBV

Birth: From an infected

mother to newborn at birth
(about 40% of chronic HBV infection
in Asia)

B...
Global Elimination of Hepatitis B
Transmission is Feasible
1981, the first hepatitis B

vaccine was FDA
approved. World H...
Hepatitis B Immunization would Reduce the Future
Burden of Chronic Hepatitis B infection and Liver Cancer
in China
12

HBs...
WHO Western Pacific Region
Hepatitis B Control Goal
In 2005, all member states adopted the goal to reduce

prevalence of ...
Founded in 1996 to address the disproportionately high

prevalence of chronic hepatitis B and liver cancer in Asians
and ...
ALC: Spearheads efforts leading to Changes in U.S. Policies to
Address the Gaps in HBV Prevention and Control
 2008, Offi...
Bringing the Communities
Together to Fight Hepatitis B and Liver Cancer:

Jade Ribbon

Jade = Good health and longevity
Re...
Advocacy: Increase WPRO and Country Level Capacity in
Viral Hepatitis Prevention and Treatment
Partner with US CDC and

a...
Vietnam, Hanoi, 2012
Partner with
US CDC to
Support the
National
Workshop on
Hepatitis
Prevention and Control to
develop 2...
Sept 2004: ALC and ACS invited to Manila to Examine Ways to
Improve Liver Cancer Prevention and Control by Philippine
Canc...
Recommendations Made at Interactive Panel
Discussion on Liver Cancer, Manila, Sept. 2004
Two recommendations
 Include Hep...
Cancer screening
Cancer screening

* Wong SN et al. WJH 2013
Early detection of HCC by ultrasound and AFP Screening
of HBsAg positive Persons to Improve Survival
Small 1.2 cm HCC dete...
Challenges and Limitations in HCC
Treatment
Global mortality to incidence ratio of liver cancer is 0.95
More complicated...
Antiviral Rx

Antiviral Rx

* Wong SN et al. WJH 2013
New oral suppressive antiviral therapies are

highly effective with low drug resistance

 One of them (tenofovir) is the...
85% reduction in
deaths from
cirrhosis

Toy, M et al. Hepatology 2014, in press
Vaccination
Eliminate mother to child transmission
Safe injection and blood banking
Protected sex

monitoring

Antiviral R...
2010 Institute of Medicine Report on Hepatitis
and Liver Cancer: Major Hurdle in Chronic Viral
Hepatitis Prevention and Co...
JRC: Uniting the Community to
Prevent and Treat Hepatitis B

San Francisco: First City in the US
to test, vaccinate or tre...
Hepatitis B Infant Vaccination Coverage

Source: WHO
Dr samuel so hep b liver ca summit
Dr samuel so hep b liver ca summit
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Dr samuel so hep b liver ca summit

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Dr. Samuel So
Director, Asian Liver Center
Stanford University

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  • Hepatitis b virus do not have medical cure because the virus is capable of hiding within the human cells, it remains protected from your immune system. Hepatitis abc isn’t a special virus – your immune system has the tools to fight it back. But because it is able to lay dormant in protected cells, your immune system is unable to remove it from your body,But this herbal medication is very strong and reactive in getting rid of the virus gradually and totally from your body without damaging any of your cells, Am so happy, i never believe i will be this happy again in life, I was working as an air-hoster ( cabby crew ) for 5 years but last year i loose my job because of this deadly disease called Hepatitis B (HbsAg), I never felt sick or have any symptom, till all workers were ask to bring their doctor report, that was how i got tested and i found out that am HbsAg positive that make me loose my job, because it was consider as an STD and is incurable disease, i was so depress was thinking of committing suicide, till i explain to a friend of mine, who always said to me a problem share is a problem solved, that was how she directed me to this clinic called HEALTH MED LAB CLINIC, that was how i contacted them and i get medication from them and i got cured for real, I just went back to my work and they also carry out the test to be real sure and i was negative. Please contact this clinic if you are hepatitis B positive their email is ( healthmedlab@gmail.com ) they are life saver.,the herb kills the virus totally not reducing just the out break okay… write email to: healthmedlab@gmail.com
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Dr samuel so hep b liver ca summit

  1. 1. Samuel So, MBBS, FACS Lui Hac Minh Professor Professor of Surgery Director, Asian Liver Center Stanford University School of Medicine Manila, February 2014
  2. 2. Liver Cancer 7th most common cancer in the world Ranks 2nd in causing the most cancer deaths each year (746,000 deaths in 2012) Among the most deadly cancers with a mortality to incidence ratio of 0.95
  3. 3. Western Pacific Region has the Greatest Burden of Liver Cancer in the World WPRO accounts for 66% of new liver cancer cases and deaths each year
  4. 4. Top 5 Causes of Cancer Deaths in the Philippines Men Women Both Sexes 1 2 Lung Liver Breast Cervix Lung Breast 3 Prostate Lung Liver 4 5 Colorectal Leukemia Colorectal Colorectal Leukemia Liver Source: GLOBOCAN 2012, (IARC)
  5. 5. Liver cancer deaths will double in 20 yrs GLOBOCAN 2012 (IARC)
  6. 6. Liver Cancer is A Leading Cause of Cancer Death in Countries where Chronic Hepatitis B is Prevalent Thailand Vietnam China Korea Philippines Indonesia Singapore Malaysia India Australia New Zealand Chronic hepatitis B prevalence ≥ 7% ≥ 7% ≥ 7% ≥ 7% ≥ 7% ≥ 7% ≥ 7% ≥ 7% ~ 3% < 2% < 2% Liver cancer ranking as cause of cancer death in men 1 1 2 2 2 3 3 4 7 11 12 Source: WHO International Agency for Research on Cancer, GLOBOCAN 2008 http:// http://globocan.iarc.fr/ US CDC, <http://www.cdc.gov/mmwr/PDF/rr/rr5708.pdf>
  7. 7. Transmission of HBV Birth: From an infected mother to newborn at birth (about 40% of chronic HBV infection in Asia) Blood: Direct contact with infected blood  Unsafe injections or transfusions in the Healthcare setting cause up to 20 million infections a year  Open wound contact, sharing contaminated toothbrush or razors  Sharing or reusing needles for tattoos, piercing and drug use Sex: Unprotected sex CDC. Available at: www.cdc.gov/ncidod/diseases/hepatitis/b/faqb.htm
  8. 8. Global Elimination of Hepatitis B Transmission is Feasible 1981, the first hepatitis B vaccine was FDA approved. World Health Organization calls “The First Anti-Cancer Vaccine” 3 Shots given over 6 months can Protect You for Life
  9. 9. Hepatitis B Immunization would Reduce the Future Burden of Chronic Hepatitis B infection and Liver Cancer in China 12 HBsAg Prevalence (%) 10 11.3 9.7 1992 2006 11.5 10.2 9. 6 9.9 9.3 8.0 8 8.2 8.1 8.3 7.6 6 5.4 4 3.2 2 0 1.0 1~ Impact of infant immunization after 14 years: Prevented up to 20 million chronic infection Prevented up to 3.5 million future deaths from liver cancer and liver disease 1.4 5~ 10~ Liang X, et al. Vaccine 2013 (in press) Liang X, et al. J Infect Dis 2009; 200: 39-47 Courtesy of Prof Zhuang Hui, PKU 15~ 20~ 30~ 40~ 50~ Age (Yrs)
  10. 10. WHO Western Pacific Region Hepatitis B Control Goal In 2005, all member states adopted the goal to reduce prevalence of chronic hepatitis B to < 2% among children 5 years of age by 2012. Hepatitis B birth dose coverage (given within 24 hours) over 65% Hepatitis B complete 3 dose coverage over 85% In 2013, all member states adopted a new goal to reduce prevalence of chronic hepatitis B to < 1% among children 5 years of age by 2017.
  11. 11. Founded in 1996 to address the disproportionately high prevalence of chronic hepatitis B and liver cancer in Asians and Asian Americans (funded by donations, foundations and federal grants) Goal: eliminate HBV transmission, stigma and complications, and reduce the incidence and mortality of HCC worldwide Focus on addressing the gaps in education, prevention, treatment and country policies by a four-pronged approach  C - collaboration (public and private)  A - evidence-based advocacy (guide country policies)  R - research (liver cancer and health policy)  E - education (public, healthcare providers, policy makers) Liver.stanford.edu
  12. 12. ALC: Spearheads efforts leading to Changes in U.S. Policies to Address the Gaps in HBV Prevention and Control  2008, Office of Minority Health recognized chronic HBV infection in Asians and Pacific Islanders as a serious and frequently neglected national health disparity  2008, CDC updated hepatitis B screening guidelines  2010, Institute of Medicine report on a national strategy on prevention and control of hepatitis calls for the nation to act now  Partner with legislators:  Hepatitis and Liver Cancer Bills introduced in Congress (2009, HR 3974) and Senate (2010)  2010 Resolution passed by state of California to recognize Hepatitis Awareness Week in May  2012, CDC updated guidelines for HBV infected healthcare workers
  13. 13. Bringing the Communities Together to Fight Hepatitis B and Liver Cancer: Jade Ribbon Jade = Good health and longevity Recognized as the universal symbol to raise awareness about HBV and liver cancer and support those living with hepatitis B
  14. 14. Advocacy: Increase WPRO and Country Level Capacity in Viral Hepatitis Prevention and Treatment Partner with US CDC and advocate to policy leaders & donors (including Zeshan Foundation)to support & strengthen WPRO viral hepatitis B initiatives:  FT Hepatitis staff in China  P5 Hepatitis medical officer and admin in WPRO  ALC/APAVH provide partial funding to create WPRO Hepatitis B website and funding/messaging for annual
  15. 15. Vietnam, Hanoi, 2012 Partner with US CDC to Support the National Workshop on Hepatitis Prevention and Control to develop 2013-2017 national action plan Phu Tho field visit & Hanoi,2013 Invited by MOH to assist in developing communications and training tools and strategies Lao PDR, 2011 Developed banners to improve infant immunization Partner with MOH in Lao PDR and WHO Mongolia, 2013 Invited by vice Minister of Health to identify national priorities beyond infant immunization Partner with WHO country office and FIRE (NGO)
  16. 16. Sept 2004: ALC and ACS invited to Manila to Examine Ways to Improve Liver Cancer Prevention and Control by Philippine Cancer Society, DOH and Philippine Gastroenterology Society
  17. 17. Recommendations Made at Interactive Panel Discussion on Liver Cancer, Manila, Sept. 2004 Two recommendations  Include Hep B vaccination in the national free infant immunization program  Give the first dose within 24 hours of birth Senator Pia Cayetano led the fight in making these changes into Law.
  18. 18. Cancer screening Cancer screening * Wong SN et al. WJH 2013
  19. 19. Early detection of HCC by ultrasound and AFP Screening of HBsAg positive Persons to Improve Survival Small 1.2 cm HCC detected on routine screening in “healthy” 53 year old Asian HBV carrier with normal AFP and ALT Arterial phase CT Venous phase CT
  20. 20. Challenges and Limitations in HCC Treatment Global mortality to incidence ratio of liver cancer is 0.95 More complicated than other cancers because most patients have 2 diseases: Liver cancer Cirrhosis (often from underlying chronic viral hepatitis) Both can be fatal. The severity of the underlying cirrhosis limits cancer treatment option and outcome. <30% are resectable at presentation Systemic chemotherapy is not very effective Transplantation and TACE treatments are expensive Recurrence rate after initial treatment is high, so costly longterm surveillance with CT/MRI scans and repeat treatments for recurrence are necessary to improve survival
  21. 21. Antiviral Rx Antiviral Rx * Wong SN et al. WJH 2013
  22. 22. New oral suppressive antiviral therapies are highly effective with low drug resistance  One of them (tenofovir) is the same drug that the health system in the Philippines is using to treat HIV/AIDS. Putting patients with liver damage on antiviral therapy  Can prevent disease progression and reduce risk of death and costly complications associated with liver cirrhosis and liver cancer Without appropriate chronic disease management, 15-25% of chronically infected persons will die from liver cancer or liver disease Lok,McMahon. AASLD practice guideline:chronic HBV: Update 2009. Hepatology 2009; 50(3):1-36 2012 Physician’s guide to hepatitis B. A silent killer. Asian Liver Center, 2011
  23. 23. 85% reduction in deaths from cirrhosis Toy, M et al. Hepatology 2014, in press
  24. 24. Vaccination Eliminate mother to child transmission Safe injection and blood banking Protected sex monitoring Antiviral Rx Cancer screening Antiviral Rx Cancer screening
  25. 25. 2010 Institute of Medicine Report on Hepatitis and Liver Cancer: Major Hurdle in Chronic Viral Hepatitis Prevention and Control Morbidity and Mortality related to hepatitis B and hepatitis C Lack of Public Awareness Lack of Provider Awareness Lack of Public Resource Allocation
  26. 26. JRC: Uniting the Community to Prevent and Treat Hepatitis B San Francisco: First City in the US to test, vaccinate or treat all Asians and Pacific Islanders for hepatitis B Make routine hepatitis B testing by PCP the standard of care See a doctor who will test you Meredith et al. J Community Health, 2011
  27. 27. Hepatitis B Infant Vaccination Coverage Source: WHO

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