Epidemiology
National Prevention of Hepatocellular Carcinoma in Japan Based on Epidemiology of Hepatitis C Virus Infection in the General Population
Hiroshi Yoshizawaa, Junko Tanakaa, Yuzo Miyakawab
aDepartment of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, and bMiyakawa Memorial Research Foundation, Tokyo, Japan
Address of Corresponding Author
Intervirology 2006;49:7-17 (DOI: 10.1159/000087257)
Key Words
- Chronic hepatitis
- Cirrhosis
- Epidemiology
- Hepatitis C virus
- Hepatocellular carcinoma
- Prevention
- Transfusion
Abstract
During the past 30 years, hepatocellular carcinoma (HCC) in Japan has kept linearly increasing from 10 to 30 per 100,000 population per year and is expected to grow further. The increment is attributed to infection with hepatitis C virus (HCV). Hence, there is a pressing need to find subjects with persistent HCV infection in the general population of Japan and take necessary measures to prevent HCC developing in them. As a first approach toward this goal, the sex- and age-specific prevalence of ongoing HCV infection was surveyed in 3,485,648 first-time blood donors during 1995-2000. Taking into account the size of subpopulations with different sex and age in Japan registered at the Census 2000, there are an estimated 884,954 HCV carriers aged from 16 to 69 years, and 759,316 (86%) of them are older than 40 years, with an increased risk for HCC; they are hidden in the society, without overt liver disease. The national 5-year project searching for HCV carriers in the general population was started in April 2002. Subjects are examinees of health check-ups, which they receive every 5 years when reaching the age of 40, as well as those at increased risk for HCV infection. The project detected HCV RNA in 14,672 of the 1,298,746 (1.1%) health check examinees and in 16,721 of the 624,734 (2.7%) high-risk individuals during the first fiscal year. Subjects found with HCV RNA have been referred to clinics and hospitals with expert hepatologists. Hopefully, this project will decrease HCC development in HCV carriers in Japan and be considered in other countries where increases in HCC are predicted from the current age-specific prevalence of anti-HCV. Copyright © 2006 S. Karger AG, Basel
References
- 1.
- Lee WM: Hepatitis B virus infection. N Engl J Med 1997;337:1733-1745.

- 2.
- Cohen J: The scientific challenge of hepatitis C. Science 1999;285:26-30.

- 3.
- Szmuness W, Stevens CE, Harley EJ, Zang EA, Oleszko WR, William DC, Sadovsky R, Morrison JM, Kellner A: Hepatitis B vaccine: Demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States. N Engl J Med 1980;303:833-841.

- 4.
- Chang MH, Chen CJ, Lai MS, Hsu HM, Wu TC, Kong MS, Liang DC, Shau WY, Chen DS: Universal hepatitis B vaccination in Taiwan and the incidence of hepatocellular carcinoma in children. N Engl J Med 1997;336:1855-1859.

- 5.
- Hoofnagle JH: Course and outcome of hepatitis C. Hepatology 2002;36:S21-S29.

- 6.
- Hoofnagle JH: Chronic hepatitis B. N Engl J Med 1990;323:337-339.

- 7.
- Alter HJ, Seeff LB: Recovery, persistence, and sequelae in hepatitis C virus infection: A perspective on long-term outcome. Semin Liver Dis 2000;20:17-35.

- 8.
- Seeff LB: Natural history of chronic hepatitis C. Hepatology 2002;36:S35-S46.

- 9.
- Kiyosawa K, Sodeyama T, Tanaka E, Gibo Y, Yoshizawa K, Nakano Y, Furuta S, Akahane Y, Nishioka K, Purcell RH, Alter HJ: Interrelationship of blood transfusion, non-A, non-B hepatitis and hepatocellular carcinoma: Analysis by detection of antibody to hepatitis C virus. Hepatology 1990;12:671-675.

- 10.
- Tong MJ, el-Farra NS, Reikes AR, Co RL: Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med 1995;332:1463-1466.

- 11.
- Kenny-Walsh E: Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin. N Engl J Med 1999;340:1228-1233.

- 12.
- Vogt M, Lang T, Frosner G, Klingler C, Sendl AF, Zeller A, Wiebecke B, Langer B, Meisner H, Hess J: Prevalence and clinical outcome of hepatitis C infection in children who underwent cardiac surgery before the implementation of blood-donor screening. N Engl J Med 1999;341:866-870.

- 13.
- Hamada H, Yatsuhashi H, Yano K, Daikoku M, Arisawa K, Inoue O, Koga M, Nakata K, Eguchi K, Yano M: Impact of aging on the development of hepatocellular carcinoma in patients with posttransfusion chronic hepatitis C. Cancer 2002;95:331-339.

- 14.
- Yoshizawa H: Hepatocellular carcinoma associated with hepatitis C virus infection in Japan: Projection to other countries in the foreseeable future. Oncology 2002;62:S8-S17.

- 15.
- Tanaka J, Kumagai J, Katayama K, Komiya Y, Mizui M, Yamanaka R, Suzuki K, Miyakawa Y, Yoshizawa H: Sex- and age-specific carriers of hepatitis B and C viruses in Japan estimated by the prevalence in the 3,485,648 first-time blood donors during 1995-2000. Intervirology 2004;47:32-40.

- 16.
- Iida F, Iida R, Kamijo H, Takaso K, Miyazaki Y, Funabashi W, Tsuchiya K, Matsumoto Y: Chronic Japanese schistosomiasis and hepatocellular carcinoma: Ten years of follow-up in Yamanashi Prefecture, Japan. Bull World Health Organ 1999;77:573-581.

- 17.
- Tanaka Y, Hanada K, Orito E, Akahane Y, Chayama K, Yoshizawa H, Sata M, Ohta N, Miyakawa Y, Gojobori T, Mizokami M: Molecular evolutionary analyses implicate injection treatment for schistosomiasis in the initial hepatitis C endemics of Japan. J Hepatol 2005;42:47-53.

- 18.
- Frank C, Mohamed MK, Strickland GT, Lavanchy D, Arthur RR, Magder LS, El Khoby T, Abdel-Wahab Y, Aly Ohn ES, Anwar W, Sallam I: The role of parenteral antischistosomal therapy in the spread of hepatitis C virus in Egypt. Lancet 2000;355:887-891.

- 19.
- Yoshizawa H, Tanaka J: A national project for the management of viral hepatitis toward prevention of hepatocellular carcinoma in Japan; in Morrissey RF (ed): International Kilmer Conference Proceedings. Laval, Polyscience Publications, 2004, vol 8, pp 247-264.
- 20.
- Beck JR: Markov models of natural history. J Clin Epidemiol 1988;41:619-621.

- 21.
- Tanaka J, Kumada H, Ikeda K, Chayama K, Mizui M, Hino K, Katayama K, Kumagai J, Komiya Y, Miyakawa Y, Yoshizawa H: Natural histories of hepatitis C virus infection in men and women simulated by the Markov model. J Med Virol 2003;70:378-386.

- 22.
- Williams I: Epidemiology of hepatitis C in the United States. Am J Med 1999;107:S2-S9.

Author Contacts
Hiroshi Yoshizawa, MD Department of Epidemiology, Infectious Disease Control and Prevention Graduate School of Biomedical Sciences, Hiroshima University Kasumi 1-2-3, Minami-ku, Hiroshima 734-8551 (Japan) Tel. +81 82 257 5162, Fax +81 82 257 5164, E-Mail juntan@hiroshima-u.ac.jp
Article Information
Number of Print Pages : 11
Number of Figures : 10, Number of Tables : 0, Number of References : 22
Publication Details
Intervirology (International Journal of Basic and Medical Virology)
Vol. 49, No. 1-2, Year 2006 (Cover Date: 2006)
Journal Editor: Liebert, U.G. (Leipzig)
ISSN: 0300-5526 (print), 1423-0100 (Online) For additional information: http://www.karger.com/int
Drug Dosage / Copyright
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center. |
|
|