Hepatitis B is a long-term infection that affects the liver. Many people with hepatitis B feel healthy and have no symptoms, sometimes for decades. But even without symptoms, the virus can quietly damage the liver and lead to serious problems such as cirrhosis or liver cancer. Because of this, hepatitis B needs lifelong treatment. That care works best when primary care doctors and liver specialists work together.
Hepatitis B care is a shared responsibility
Hepatitis B can be diagnosed in primary care settings. Primary care doctors order blood tests, provide vaccines, manage other health conditions, and often have longstanding relationships with their patients. They are usually the doctors people see regularly and trust the most.
Liver specialists—such as hepatologists, gastroenterologists, or infectious disease doctors—have deeper training in liver disease. They help decide when treatment is needed, assess liver damage, and guide screening for liver cancer. They are especially important when hepatitis B becomes more active or complications arise.
What happens when care is not coordinated
When primary care and specialty care are not connected, people living with hepatitis B can miss critical steps in care. For example:
A patient may not be referred to a specialist when needed.
Blood tests or ultrasounds may be delayed or forgotten.
Liver cancer screening may not happen regularly.
Patients may feel confused about whether their condition is serious.
Because hepatitis B often causes no pain or has minimal, if any, symptoms, these gaps can go unnoticed. Sadly, some people only learn they have a serious infection when they are diagnosed with advanced liver disease or liver cancer.
Teamwork leads to better health
When primary care doctors and liver specialists work as a team, care becomes clearer and safer. Primary care doctors can handle routine visits, manage overall health, and make sure labs and imaging are scheduled. Liver specialists can guide treatment decisions and provide clear plans for monitoring.
This shared approach helps patients stay on track, reduces duplication of tests, and ensures problems are caught early.
Collaboration helps reduce health inequities
Hepatitis B is more common in some communities, especially Asian, Pacific Islander, African and immigrant populations. Many people face language barriers, stigma, or limited access to liver specialists.
Primary care providers are often closer to these communities, and have a deep understanding of each community’s unique needs. Specialists bring expertise but may not always be easy to reach. Working together helps bridge these gaps, improves education, and supports culturally appropriate care.
Preventing liver cancer requires ongoing communication
People with hepatitis B have a higher risk of developing liver cancer, even if they feel fine. Regular screening, usually occurring every six months, can detect cancer early, when treatment works best. Specialists may recommend screening, but primary care doctors often help make sure it actually happens.
Hepatitis B is a lifelong condition that requires long‑term planning and follow‑up. When primary care doctors and liver specialists work together, patients get better monitoring, receive clearer guidance, and a better chance to stay healthy. Collaboration among primary care providers, liver specialists, and patients is essential for preventing liver disease, reducing disparities, and saving lives.
For people living with chronic hepatitis B, regular testing is an important part of staying healthy. Blood tests and imaging, such as ultrasounds, help doctors monitor the individual patient’s health and the effectiveness of whatever medications they may be taking and even find liver cancer early, which increases the effectiveness of treatment. Even so, many people feel anxious about monitoring. It is common to worry before appointments or feel stressed while waiting for results. Research shows that this kind of anxiety is very common among people living with hepatitis B (Low et al., 2025).
The good news is that there are strategies and ways to help reduce the anxiety associated with screening and monitoring liver cancer. These strategies do not eliminate the need for monitoring, but they can make it much easier to manage the worry that comes with it.
Evidence‑Based Coping Strategies
Learn what monitoring is for and what results mean. People feel less anxious when they understand why tests are done and what different results mean. Clear explanations from health care providers, such as explaining that unclear or abnormal results do not always mean cancer, can reduce fear and stress (Hui et al., 2026).
Ask direct questions during appointments. Questions like “What is this test checking for?” or “What happens if something looks different?” can help replace worry with facts and reduce uncertainty (Hui et al., 2026).
Use mental health tools to manage worry. Research shows that cognitive behavioral therapy (CBT) and mindfulness practices help people notice anxious thoughts and calm their reactions. Simple steps such as deep breathing, guided relaxation, or focusing on the present moment can help during scan weeks (Low et al., 2025).
Plan ahead for testing days. Having a plan helps people feel more in control. This may include scheduling something relaxing after an appointment, choosing a friend or family member to talk to, or limiting time spent searching online for alarming information (Low et al., 2025).
Lean on social support. Talking with others who understand—such as support groups, patient programs, or trusted loved ones–can reduce feelings of isolation and anxiety. Feeling supported makes coping easier (Low et al., 2025).
Treat mental health as part of liver health. Experts recommend screening for anxiety and depression as part of hepatitis B care. Counseling or emotional support can improve quality of life and help people stay engaged in important monitoring (Low et al., 2025).
Studies show that even though monitoring can be stressful, most patients still want to continue because it helps save lives (Hui et al., 2026). The goal is not to stop testing, but to support emotional well‑being along the way.
Liver cancer monitoring helps catch problems early, but living with constant check‑ups can be stressful. With clear information, mental health support and simple coping strategies, patients can stay connected to care while also protecting their well‑being.
Liver cancer is a serious disease that can be difficult to detect early. When a patient’s symptoms raise a concern, physicians usually use medical images, such as CT scans or MRIs, to look for signs of cancer or abnormal growth in the liver. But sometimes, these images are challenging to read, and small tumors can be missed. That’s where artificial intelligence (AI) comes in.
A recent study looked at how AI is being used to help doctors find and understand liver cancer better.
What is AI?
AI stands for artificial intelligence, which means computer programs that can learn from data and make decisions or predictions. In medicine, AI can look at lots of information, such as diagnostic images of the body, lab test results and patient history, and find patterns that might show signs of disease.
How is AI used in liver cancer?
In liver cancer, AI can be used to:
Find tumors: AI can scan medical images and spot areas that look unusual (this can indicate abnormal tissue growth or cancer cells), even if they’re very small.
Measure tumors: It can outline the shape and size of a tumor, which helps doctors plan treatment.
Predict risks: AI can estimate how likely it is that the cancer will come back or spread.
Help choose treatments: Based on the available data, AI can suggest which treatments might work best for a patient.
What kinds of AI tools are there?
Researchers are using different types of AI tools to help study liver cancer. Each tool works in its own way, but they all have the same goal: to look at medical data and help doctors understand what’s going on inside the body.
Here are the main types:
Machine Learning (ML):
Machine learning is a type of computer program that learns from examples. For liver cancer, it might look at thousands of patient records and medical images to learn what cancer looks like. Once it’s trained, ML can analyze new cases and predict whether someone might have cancer or how serious it is.
Think of it like teaching a computer to recognize patterns, just like how you might learn to spot different dog breeds by looking at lots of pictures.
Deep Learning (DL)
Deep learning is a more advanced kind of machine learning. It’s especially good at looking at pictures, such as CT scans or MRIs, and finding tiny details that might be hard for a human to see. These tools use a neural network, which is a system that works kind of like a human brain; it connects lots of pieces of information to make decisions.
Deep learning is often used to find small tumors, measure their size and even tell if they’re likely to grow or spread.
Multi-Modal Systems
“Multi-modal” means using more than one type of information at the same time. These systems combine medical images with lab test results, patient history and other health data. By looking at everything together, AI can give a more complete picture of the patient’s condition and medical needs.
It’s like solving a puzzle; you need all the pieces to see the full image. These tools help doctors understand not just where the cancer is, but how it might behave and what treatments could work best.
What are the challenges?
Even though AI is helpful, it’s not perfect. It needs a lot of good-quality data to work well. If the data is missing or not diverse, AI can make mistakes. Also, many AI tools are still being tested and aren’t used in hospitals yet. Doctors still need to understand how AI makes its decisions, which isn’t always easy. While it’s still being developed, artificial intelligence is helping researchers learn more about liver cancer and how to treat it.
Reference:
Wang, L., Fatemi, M., & Alizad, A. (2024). Artificial intelligence techniques in liver cancer. Frontiers in Oncology, 14, 1415859. https://doi.org/10.3389/fonc.2024.1415859
When we talk about chronic hepatitis B virus (HBV) infection, the focus is usually on the liver and for good reason. HBV is a leading cause of liver cirrhosis and liver cancer. However, new research shows that HBV’s impact goes far beyond the liver. It can increase the risk of other cancers in the body.
Hepatitis B and non-liver cancers
A major population-based study in China found that people with chronic hepatitis B had significantly higher risks of several types of cancer beyond liver cancer. These included stomach, colorectal, pancreatic, oral cancers, and lymphoma (a type of cancer that affects the immune system). For example, the risk of lymphoma was nearly double in HBV-positive individuals compared to those without the virus (Song et al., 2019). This suggests that HBV may play a role in cancer development outside the liver, possibly through long-term inflammation or high viral load that affects other tissues and nearby cells.
How hepatitis B affects other organs
Hepatitis B isn’t limited to liver cells. It can also be found in the pancreas, kidneys, and blood cells, where it may cause inflammation and target the immune system (Tang, 2020). Long-term inflammation, especially without proper treatment or management, caused by hepatitis B can raise the risk of cancer, and, because the virus can stay in different parts of the body, not just the liver, it may help explain why it’s linked to other types of cancers.
In addition to cancer, hep B can also cause inflammation in other organs. One example is kidneys. Some people with HBV develop a condition called glomerulonephritis, which is a type of kidney inflammation. Over time, this can lead to serious kidney damage if not treated.
HBV may also be linked to certain blood disorders and metabolic issues, especially when combined with other health problems such as diabetes or MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease. These conditions can make it harder for the body to stay balanced and healthy (Karayiannis, 2017).
Mental and emotional health
Living with chronic hepatitis B often can affect a person’s mental health. Some people feel anxious, stressed, or even depressed because of the stigma, the fear of passing the virus to others, or worries about their future health. These feelings can make it more challenging to stay on top of treatment and care.
What Can Be Done?
Fortunately, hepatitis B is manageable. Antiviral medications can suppress the virus, which may reduce the risk of complications and help with inflammation of not just liver cells but also other cells and tissues in the body. Regular monitoring and early treatment are key, not just for liver health, but for preventing other health issues linked to hepatitis B. Learn more about hepatitis B management and updated recommendations here. Check out our Liver Cancer Connect program to learn more about liver cancer prevention and management.
While liver cancer is one of the most serious outcomes of chronic hepatitis B, the virus can also harm other parts of the body, including the stomach, pancreas, and even the immune system. That’s why managing hepatitis B isn’t just about protecting the liver; it’s about protecting your whole health. Staying connected to care, getting regular checkups, and following treatment plans are key to detecting problems early and living well with hepatitis B.
References:
Song, C., Lv, J., Liu, Y., et al. (2019). Associations between hepatitis B virus infection and risk of all cancer types. JAMA Network Open, 2(6), e195718. https://doi.org/10.1001/jamanetworkopen.2019.5718
Tang, H. (2020). Hepatitis B Virus Infection: Molecular Virology to Antiviral Drugs. Springer. https://doi.org/10.1007/978-981-13-9151-4
Karayiannis, P. (2017). Hepatitis B virus: virology, molecular biology, life cycle and intrahepatic spread. Journal of Gastroenterology, https://doi.org/10.1007/s12072-017-9829-
Did you know that the tiny organisms living in your gut, called the microbiome, can have a strong impact on your liver? Recent research shows that the bacteria and fungi in your digestive system play a major role in keeping your liver healthy and may even affect how hepatitis B progresses.
The gut-liver connection
Your gut and liver are closely connected through something called the gut-liver axis. When your gut microbiome is balanced, it helps protect your liver by producing helpful substances such as butyrate and tryptophan. These can reduce inflammation and support liver function. But when the microbiome is out of balance (a condition called dysbiosis), harmful bacteria and toxins can leak into the bloodstream and reach the liver, causing damage (Zhang et al., 2024).
What happens in hepatitis B
Hepatitis B virus (HBV) can lead to serious liver problems, including cirrhosis. A 2025 study found that people with HBV-related cirrhosis had fewer good bacteria such as alistipes and lachnospira, and more harmful ones including Fusobacterium and Enterococcus in their gut (Chen et al., 2025). These changes were linked to lower levels of important nutrients like tocopherol, which help protect the liver.
Another study looked at how the mix of bacteria in the gut changes as hepatitis B gets worse. Researchers found that people with chronic hepatitis B had a wider variety of bacteria compared to people without hepatitis B. They also noticed changes in the balance between two major groups of bacteria (firmicutes and bacteroidetes) that are important for digestion and immune health. These shifts in gut bacteria could help doctors understand any changes or advances in hepatitis B and possibly even predict how it might develop over time (Wang et al., 2023).
Bile acids and bacteria
Bile acids, which help digest fats, also interact with gut bacteria. In HBV-related liver disease, high bile acid levels were linked to more lactobacillales and fewer clostridiales, which suggests another kind of imbalance (Zhou et al., 2025). This connection could lead to new treatments that target both bile acids and bacteria.
Your gut microbiome does a lot more than help you digest food. It’s deeply connected to your liver and can influence how hepatitis B develops and changes over time. As scientists learn more, we may see new treatments that focus on fixing the microbiome to protect and promote liver health.
References:
Chen, Y., et al. (2025). Gut microbiota and metabolomic profiles in HBV-related cirrhosis. Journal of Hepatology Research.
Li, X., et al. (2024). Gut mycobiome and liver disease: Emerging insights. Liver International.
Wang, J., et al. (2023). Microbiota diversity across HBV disease stages. Microbiome Medicine.
Zhang, L., et al. (2024). Gut microbiota and chronic liver disease: Mechanisms and interventions. Hepatology Reviews.
Zhou, H., et al. (2025). Microbiota–bile acid crosstalk in HBV-induced cirrhosis. Clinical Gastroenterology.
Hepatitis B remains a global health challenge.. There are strategies to prevent perinatal (mother to child) transmission of hepatitis B. Prevention includes testing all pregnant persons for the marker of hepatitis B infection (HBsAg), if the pregnant person is positive, then assessment is needed throughout pregnancy. If the pregnant person’s viral load becomes high, antiviral treatment (TDF) might be recommended during the second trimester taken throughout pregnancy. Data shows this is safe and effective, and reducing the viral load can reduce the risk of transmission.
Additionally, making sure that all infants get hepatitis B birth dose as soon as possible after delivery, ideally within the first 24 hours of birth followed by at least two subsequent doses of hepatitis B vaccine (usually part of global childhood immunization series ex: the pentavalent vaccination). However, for many individuals, adhering to these guidelines in many parts of the world can be a challenge. Recent research sheds light on the barriers and opportunities to improve treatment adherence during this important period. Treatment adherence means taking your medicine the right way, at the right time, in the right amount, and for as long as your doctor tells you. It’s about sticking to your treatment plan to maintain your health.
The postpartum drop-off: a hidden risk
A study published in the Journal of the Pediatric Infectious Diseases Society explored adherence to tenofovir disoproxil fumarate (TDF), a medication used to treat HBV, among pregnant individuals. While adherence during pregnancy was relatively high, many women discontinued treatment postpartum. A mix of factors contributed to the drop in HBV treatment adherence following delivery including:
Lack of follow-up care after delivery
Low awareness about health risks that may come from stopping medication
Limited knowledge about the long-term benefits of continued treatment
Healthcare system gaps, especially in low-resource settings, making access to care and medication difficult
What the numbers say?
In a broader context, a study from Israel found that only about 67% of chronic HBV patients maintained high adherence (defined as taking at least 80% of the prescribed medication). Many women stopped taking their medication after giving birth or were not consistent with their medication routines (Mor et al., 2022). A 2025 pilot study published in Virology Journal looked at what happens when women with chronic hepatitis B stop taking antiviral medication after giving birth. Among 88 women who discontinued treatment postpartum, nearly 29% experienced liver inflammation (ALT flares)—a sign that the virus was becoming elevated (Tang et al., 2025).
What can be done?
Improving postpartum adherence to HBV treatment requires a holistic approach and strategies can include:
Integrated care models that link obstetric and hepatology services, making it easier for women to stay on track with their hepatitis B care and medication
Patient education that emphasizes the importance of continued treatment beyond pregnancy
Support from community health workers to provide follow-up and encouragement to stay connected with hepatitis B care
Mobile health tools (like SMS reminders) to help new mothers stay on trackafter delivery
The postpartum period is a time of immense change—and often, medical follow-up takes a backseat. But for women living with HBV, taking efforts to prevent perinatal transmission is crucial not just for their own health, but for preventing the future generation from hepatitis B. With better systems, education, and support, we can close the adherence gap and protect more lives.
To learn more about prevention of perinatal transmission of hepatitis B, you can also visit the Hepatitis B Foundation’s Informed Training Hub, which includes modules on perinatal prevention.
References:
Greenup, A. J., Tan, J., Nguyen, V., & Visvanathan, K. (2020). Adherence to antiviral therapy for chronic hepatitis B during pregnancy and postpartum: A prospective cohort study. Journal of the Pediatric Infectious Diseases Society, 9(3), 289–295. https://doi.org/10.1093/jpids/piz064
Mor, Z., Grotto, I., & Anis, E. (2022). Adherence to antiviral therapy among patients with chronic hepatitis B in Israel. Israel Journal of Health Policy Research, 11(1), 1–9. https://doi.org/10.1186/s13584-022-00527-2
Tang, Q., Wang, C., Li, H., Chen, Z., Zhang, L., Zhang, J., Liu, X., Xue, Y., Qiu, Y., Peng, M., Zeng, Y., & Hu, P. (2025). Unexpected HBsAg decrease after nucleoside analogues retreatment among HBeAg positive postpartum women: A pilot study. Virology Journal, 22, Article 36. https://doi.org/10.1186/s12985-025-02632-x
World Health Organization. (2024). Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection (WHO Guidelines). https://www.who.int/publications/i/item/9789240090903
Did you know that people in prison are at much higher risk for hepatitis B than the general population? You would think that means there are programs in place to prevent and treat it — but unfortunately, that’s often not the case.
In a recent episode of the B Heppy podcast, researchers Heidi Emery and Kathryn Jack talk about some of the major barriers to accessing critical hepatitis B prevention and treatment services in prisons. Dr. Emery and Dr. Jack, who work at the University of Nottingham School of Medicine, reviewed prior research on the topic and spoke with people in the prison system — including those who are incarcerated, prison healthcare workers, and even guards — to understand what was happening within the prison system and hepatitis B.
You can find their published research here. Additionally, the Hepatitis B Foundation has also released a white paper on recommendations for HBV screening and prevention in corrections.
Common Barriers to Care:
Stigma and lack of information about hepatitis B
One of the biggest roadblocks? People just do not know enough about hepatitis B. There is a lot of fear and misunderstanding about how hepatitis B spreads and what it means to have it. That leads to stigma — and stigma makes people less likely to get tested or treated.
Health care isn’t always a priority in prisons
Prisons are mostly focused on safety and security — not healthcare. That means people might miss appointments because of lockdowns or staffing shortages. Even if someone wants care, they might not get it when they need it.
Lack of resources
Many prisons just don’t have the staff, funding, or systems in place to handle hepatitis B testing, treatment, or education properly. This makes it difficult for people to get timely education on hepatitis B prevention, management, and treatment.
No support after release
Often, there’s no follow-up care or connection to outside health services after someone is released from prison. So even if someone starts treatment, it might not continue. People are less likely to follow up with care when they are out of the prison system or may lack the resources to navigate the health system on their own.
Recommendations to improve care
Within this review, researchers provided recommendations on how to address these major challenges to hepatitis B prevention, care, and treatment within the prison system. They are described below-
Education makes a big difference
When people understand hepatitis B better — both those in prison and those working there, stigma goes down, and people are more likely to get help. Education programs can make a big difference to address low knowledge and stigma.
Better health systems inside and out
Connecting prison healthcare to public health systems on the outside means care doesn’t have to stop once someone is released. It can be an opportunity to make sure people stay connected to healthcare after they get out.
Policy changes that put health first
Routine testing and vaccinations for hepatitis B should be part of prison intake. With the right policies, prisons could become places where people actually get the health care they have been missing out on.
This issue is not just about prisons — it’s about public health. If we ignore hepatitis B in these high-risk settings, we miss a big chance to stop the virus from spreading in communities, too.
Alternative medicine is becoming more popular, but it can be risky, especially when it’s not regulated. This is a big concern for people living with hepatitis B in places where access to medical care and treatment options may be limited. Some people sell untested treatments, promising quick cures without any scientific proof. These treatments can actually make things worse for patients. It is also important to note that currently there is no cure for hepatitis B but there are safe and effective medications to manage your condition and improve your health.
Why unregulated alternative medicine is risky:
When alternative medicine isn’t regulated, it means the treatments haven’t been properly tested. For hepatitis B patients, using these treatments can lead to serious health problems. The safety and effectiveness of these treatments aren’t guaranteed, and they can sometimes cause more harm than good. Some practitioners claim their treatments work because of divine intervention and charge high fees, taking advantage of patients’ financial circumstances and leading to false hope in their medical care.
Why evidence-based health decisions are important:
Making health decisions based on scientific evidence is crucial. Evidence-based medicine uses the best available research and clinical expertise to make decisions about patient care. This approach helps ensure treatments are safe and effective.
For people living with hepatitis B, evidence-based methods are especially important. Chronic hepatitis B can cause serious liver damage, and managing the condition requires careful monitoring and appropriate treatment. The World Health Organization (WHO) warns that while some alternative medicine practices can be beneficial, the lack of regulation and scientific validation can make them dangerous.
While the idea of quick fixes through alternative medicine can be tempting, it’s essential for hepatitis B patients to prioritize evidence-based treatments. By doing so, they can make the best decisions for their health and well-being. Always consult healthcare professionals and rely on credible sources to guide your health decisions.
Safe and effective treatment for hepatitis B:
People with chronic hepatitis B can live long and healthy lives by making liver-friendly choices like regular check-ups, avoiding alcohol and tobacco, and eating healthily. Approved drugs for adults and children help control the virus and reduce the risk of serious liver disease, though there’s no complete cure yet.
Treatments fall into two categories:
Immune modulator drugs: Interferon-type drugs that boost the immune system to fight the virus, given as shots for 6 months to 1 year.
Antiviral drugs: Pills taken daily to stop or slow the virus, reducing liver inflammation and damage, usually taken for at least 1 year.
Not everyone with chronic hepatitis B needs treatment; it’s most effective for those showing signs of active liver disease.
Helpful resources for hepatitis B patients
To make informed health decisions, it’s important to rely on credible sources and consult healthcare professionals. It’s also important to do your own research to find out more about the benefits or harms of a medication or herbal treatment. Here are some resources to help:
Centers for Disease Control and Prevention (CDC): The CDC provides comprehensive information on Hepatitis B treatment options, including antiviral medications and lifestyle recommendations.
Hepatitis B Foundation: This organization offers detailed guidance on managing Hepatitis B, including the latest research on treatment options.
In honor of Liver Cancer Awareness Month, the Hepatitis B Foundation sat down with Ivory Allison, National Senior Director of Community Impact at the American Liver Foundation (ALF), to discuss what this month means to ALF, how they celebrate, and why addressing liver cancer is so important. Read on to learn more!
Could you please share a little bit about the history, vision, and mission of the American Liver Foundation (ALF) and what are some of the programs and activities that you lead?
Absolutely. First, thank you for inviting the American Liver Foundation to be a part of this. We are very excited to have this opportunity. Partnering with the Hepatitis B Foundation is something that we’ve done for a very long time, and we enjoy having the opportunity to continue this partnership, especially during October.
The American Liver Foundation was created in 1976, so we are 48 years old. we were created by the American Association for the Study of Liver Disease (AASLD). That organization is comprised of scientists and healthcare professionals, who at the time were concerned with the rising incidence of liver disease and the lack of awareness amongst both the public and the medical community at that time. The mission of ALF was to complement the programs and services provided by AASLD. So, they focused on medical professionals, and we focused on patients and the general public. We are a 501(c)3 nonprofit and our mission is to promote education, advocacy, support services, and research for the prevention, treatment, and cure of liver disease. When you look at that, that’s huge to cover because we don’t focus on any specific liver disease – our focus is on liver disease in general.
We try and make a measurable difference in the fight against liver disease by providing financial support for medical research. We have a research department and education for medical professionals. For example, we had a few education programs this past summer. We launched a program called Project ECHO for medical professionals and providers to learn more about MASLD, or fatty liver disease, and we’re going to continue that the rest of this year, every month, and continue it hopefully in 2025. And of course, programs for advocacy and information for patients, including educating patients and their families by creating public awareness campaigns about liver wellness and disease prevention, are our focus.
I currently oversee a few different initiatives. One of them is our liver cancer initiatives which include a two-day liver cancer conference that we’ve held since 2020, called the Educated Patient for patients and caregivers. This year we’re trying something new where we are focusing on a liver cancer series that we actually kicked off in September, specifically for pediatric liver cancer, because September was Pediatric Cancer Awareness Month. In October, we actually have two programs that will be happening for liver cancer and then we have one that will be ending in November. The other couple programs that I’ve overseen include our Rare Liver Disease Summit, our autoimmune forum, and our pediatric initiatives.
I also oversee some of our collaborations with the Center for Disease Control Viral Hepatitis Division. I have worked with them for the last three or four years on programs, including hepatitis C barriers to treatment in community-focused primary care.
Is there anything in particular or maybe a couple of things that you enjoy most about your work?
I really enjoy working with the partners, and our partner organizations. Hepatitis B, hepatitis C, and other liver diseases affect so many people, especially in diverse communities and that’s also something that I’m glad that we have had the opportunity to focus on that under our CEO Lorraine Stiehl, who’s made that a priority. Liver disease, of course, affects so many different people and to be intentional about making sure that we focus on these particular groups where liver cancer is high is crucial. Being able to do programming and targeting these communities to educate them is something that I think has been exciting.
What are some of the primary causes of liver cancer?
Hepatitis B and hepatitis C are common risk factors for liver cancer worldwide and people who are infected with both viruses have an even higher risk. There are certain risks to getting liver inflammation such as heavy alcohol use and tobacco use of course. MASLD is also a high-risk factor for liver cancer. What ALF has been trying to do is have programs specifically for risk factors for liver cancer. But people who have hepatitis B, hepatitis C, or MASLD often don’t realize that they are at high risk for liver cancer. So, our goal is to go to those communities to educate them about the potential risk of liver cancer.
Why is early detection of liver cancer so important and what are some strategies that can be used to increase prevention and early detection of liver cancer?
Improving early access to screening, education, and treatment is vital. This includes educating the general public and people who have liver disease about liver cancer, so that we can prevent it. It is difficult when people have liver cancer and have to go through treatment or get a liver transplant.
At ALF, we have a public health campaign called Think Liver Think Life. It’s a national public health campaign that which aims to ensure every American understands their risk for liver disease, factoring in things like drinking heavily, smoking, and being in the “baby boomer” generation. We tried to allow for the appropriate screening and care coordination through this campaign. We have liver health specialists that go around the country to different events educating and raising awareness and providing screenings in some locations about these risk factors.
What are the barriers when it comes to raising awareness or implementing screening protocols?
Resources and language barriers. For us, we have someone on staff who oversees our connection to care. For example, when we’re out in the community educating people about liver disease, doing screenings, or are at the clinic, we have someone on our team who is bilingual in Spanish, and she can connect with these patients. We have also made multiple languages available on our website, so you can translate the website from English to Spanish, Chinese, or Italian. This has been very helpful for many people. Also, when you talk about certain communities who are so focused on their families and work, they put their health on the back burner. They’re focusing on feeding their children, taking care of their families, and they aren’t putting their health as the number one priority. And we see that all over, right?
What we’re trying to do now is to make it so that we are educating the whole family, instead of focusing on one person. We’re trying to say to the mom, “This is important.” If your child has MASLD or someone in your family may be at high risk, it’s important for not just them, but for you as well to be screened and tested because many people, especially women, put their children’s health before their own. We like to say, if we can educate the mom or the wife, we educate the whole family.
So, make sure you’re getting screened because when your family sees what you’re doing, they’ll normally follow through. They will also make sure that they’re getting screened or that they’re eating healthy and cutting back on cigarette and alcohol use.
Is there any advice you would give to someone who is currently living with liver cancer, someone who’s indirectly impacted, or someone at high risk of liver cancer?
For someone living with liver cancer it is important to not isolate yourself. I can imagine it is very overwhelming and very scary to be diagnosed with liver cancer and living with liver cancer. But make sure that you are communicating with your family, friends, especially your doctor, and connecting with others who are going through what you’re going through. At ALF, we have a private liver cancer Facebook group for patients as well as caregivers. You can also join that group to find that community so you can connect with people and talk with people. We also have monthly support groups at the American Liver Foundation via Zoom, moderated by a licensed social worker. You can connect with others and just talk. You see a lot of people who are going through liver cancer who get depressed, and it’s really difficult for them to continue with treatment. So, I would say, don’t isolate yourselves. Find your community. If it’s two people, three people, whoever it is, and make sure you continually connect with your medical team. Get to know your team and understand that you’re the boss of your healthcare team. Don’t be afraid to communicate with them and let them know what’s happening or what’s going on. If you’re not comfortable with your team, first talk to them. If you’re still not feeling that team, move on, because again, you’re the number one.
If you’re at high risk for liver cancer, I would say, again, talk to your medical providers and find out what the next steps are and what you can do to prevent liver cancer. Talk to them, educate yourself, but don’t overwhelm yourself. Educate yourself because what the medical providers tell you may be overwhelming. Also, get vaccinated against hepatitis B, get tested for hepatitis C, and get medical care if you have either virus.
Why is it important to have a month specifically dedicated to liver cancer awareness, and what are some activities that ALF is involved in to celebrate liver cancer awareness month?
I think it’s important for us to have an opportunity to highlight this particular disease, raise awareness, and educate the public. It puts a spotlight on this disease and for an entire month, we can have campaigns and weekly programs and put a face to liver cancer so people are knowledgeable, and the importance doesn’t get lost throughout the year.
For Liver Cancer Awareness Month, we have a few things happening. We have a program on October 23rd on how to prevent liver cancer if you are at high risk. It’s going to be in Spanish. We are also releasing a video on how to be involved with your medical team and how to interact with your team.
We are also going to be releasing a 30-Day Menu of Recipes so people can hopefully check out some healthy recipes. We tell people all the time that they should eat healthily, and sometimes we realize many people don’t know what that means. To address this, we are going to be launching in October a 30-day menu. Then, of course, our Think Liver Think Life campaign will pick up a little extra in October as well.
Is there anything else you would like to share?
This year, we also launched a patient registry. It’s the first-ever patient registry for all types of liver disease, and it will help provide researchers with a better understanding of liver diseases, the impact of current treatments, and how liver disease affects patients. People can find more information at www.liverpatientregistry.org, and they can find and read about why they should participate, what they would have to do, how it works, and who can participate. And of course, they can always go to our website, www.liverfoundation.org, for more information on any of our programs, events, and policies.
Thank you so much for taking the time to speak to the Hepatitis B Foundation today! We really appreciate your time and insights, and all of the great work ALF is doing!
Birth dose is the most critical public health tool to prevent the spread of new hepatitis B infections among newborn children. Vaccination at birth provides lifelong protection against hepatitis B and reduces the chances of developing chronic hepatitis B. However, access to birth dose and vaccinations for children remains a challenge in many countries, especially countries low- and middle-income countries with high prevalence of hepatitis B, despite the availability of safe and effective vaccines.
Lack of Knowledge
Many communities are unaware of the hepatitis B virus and how it can cause severe damage to the liver, especially for newborn children. Mothers who deliver children at home or without appropriate medical care are also less likely to get the birth dose for their babies. Lack of knowledge about the spread of the virus and vaccination persists among some medical providers and professionals as well, making it harder for families to get birth dose for their children in a timely manner. Misconceptions about the virus and the vaccine also makes it difficult to get children vaccinated. Educational campaigns should focus on raising awareness about the hepatitis B virus and teaching communities about the role of the birth dose in preventing serious liver disease and death (Freeland et al., 2023).
Cost and Transportation
Many families mentioned cost to be a barrier to getting the birth dose for their children. For some mothers, they were unable to deliver at health facilities or lacked safe transportation to get to a health facility to get their children vaccinated. For families who lived in rural areas, finding a nearby health facility was a challenge. This also makes it difficult for mothers to return to the health facilities to get the remaining doses for their children.
Lack of Political Will and Advocacy
While the birth dose is available in many countries with high rates of hepatitis B, it is not always accessible to people who need it most. Local governments and health ministries must lead national vaccine advocacy campaigns to spread awareness about the availability and importance of getting children vaccinated at birth to prevent hepatitis B. Additionally, the hepatitis B birth dose should be available to all families at no cost. Vaccine advocacy efforts should focus on debunking myths and misconceptions about the virus and the birth dose.
GAVI, the Vaccine Alliance has launched a new initiative to tackle some of these challenges and expand access to hepatitis B birth dose where it is needed most. Learn more about the new vaccination programme here.
References:
Boisson, A., Goel, V., Yotebieng, M., Parr, J. B., Fried, B., & Thompson, P. (2022). Implementation Approaches for Introducing and Overcoming Barriers to Hepatitis B Birth-Dose Vaccine in sub-Saharan Africa. Global health, science and practice, 10(1), e2100277. https://doi.org/10.9745/GHSP-D-21-00277
Freeland, C., Kanu, F., Mohammed, Y., Nwokoro, U. U., Sandhu, H., Ikwe, H., Uba, B., Asekun, A., Akataobi, C., Adewole, A., Fadahunsi, R., Wisdom, M., Akudo, O. L., Ugbenyo, G., Simple, E., Waziri, N., Vasumu, J. J., Bahuli, A. U., Bashir, S. S., Isa, A., … Tohme, R. A. (2023). Barriers and facilitators to hepatitis B birth dose vaccination: Perspectives from healthcare providers and pregnant women accessing antenatal care in Nigeria. PLOS global public health, 3(6), e0001332. https://doi.org/10.1371/journal.pgph.0001332
