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Preventing Hepatitis B, Hepatocellular Cancer: Made in Taiwan

Preventing Hepatitis B, Hepatocellular Cancer: Made in Taiwan

In most developed nations, cancer is second only to heart disease
as a cause of death; in less developed countries, it is second
to infectious disease. It is estimated that if the current trends
of rising worldwide incidence continue, cancer will become the
leading cause of death in the 21st century. This is particularly
troubling since many of the factors contributing to cancer (eg,
occupation, diet, lifestyle, and tobacco use) are known.

The politics of science have had an enormous impact on the development
of public policy programs for the prevention and treatment of
many types of cancer. Highly politicized and well-financed interest
groups include environmentalists, tobacco companies, labor unions,
physicians, scientists, and patient advocates. They have the capacity
to affect which diseases and therapies are and are not researched,
evaluated, and treated, and which information is disseminated
and by what means.

Balancing these often conflicting interests affects the success
of large-scale initiatives. Despite these obstacles, broad education,
prevention, and treatment measures must be considered, to establish
control over the incidence and costs of cancer.

Excellent practical examples of highly organized and effective
initiatives are the programs developed to eradicate hepatitis
B virus infection and hepatocellular carcinoma. These programs
have proven so successful that the World Health Organization considers
hepatitis B vaccination the most important cancer prevention program
today, with the exception of smoking cessation programs.

More than 75% of the world's chronic hepatitis B carriers live
in the Asia-Pacific region. In countries with large economic resources
and a significant hepatitis B problem, such as Malaysia, Singapore,
and Taiwan, national immunization programs have reduced hepatitis
B carrier rates from approximately 10% to 1%-2% in 3 to 5 years.[1]
In China, the seropositivity rate for HBsAg has been reduced from
16.3% to 1.4% since 1986.[2] In Thailand and the Philippines,
despite fewer resources, similar improvements have been noted.

However, in countries that are poor and involved in political
turmoil, such as Myanmar, Indonesia, and Cambodia, programs have
not been initiated because of a lack of political commitment and
economic resources. Likewise, most African countries are unable
to obtain funding for vaccination programs, despite political
interest and even though it is estimated that vaccination would
control more than 75% of hepatitis B cases in Africa.[3]

In areas with a lower incidence, vaccination program development
has been variable. New Zealand has been a pioneer in hepatitis
B immunization, while Australia has not adopted any program.


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