1. Liver Cancer Prevention V.E.I.L.

2. 1. Vaccination Birth dose + 2 Universal for those not already chronics Screening pregnant women Catch up vaccination in at risk adults

3. 2. Education • Educate providers • Especially needed – develop specific tools for providers to use with patients (Education on….see below) • Public education • Educate at risk groups • Educate on: • Risk factors • Who is at risk • Safe lifestyles • Consequences of liver disease • Wake up call – increase of liver cancer

4. 2. Education (cont.) Analogy to HIV/AIDS HIV AIDS HCC risk Advanced liver disease • HBV • HCV • NASH • Obesity • Diabetes, etc. • Fibrosis • Cirrhosis • ESLD • HCC • Transplant Continuum of Care

5. 3. Identification • Identification of at risk populations • Early diagnosis to prevent progression of chronic liver disease • “No abnormal liver test is normal” • At risk “normal labs • Dashboard • What is the cascade of B, C, NASH, et al? • What is the total population at risk? • Total burden? • What proportion has been tested? • Of those who are tested, how many already have morbity ] • Of those tested, how many get linked to care? • Of those linked to care, how many get staged? • How many people are diagnosed late? Define late? • Of those who get staged, how many get treated? • Of those who get treated for HBV, how many are chronically and durably suppressed? • For HCV, how many have SVR? • For NASH, how many are on weight control, alcohol control, diabetes, etc.? • For all, how many are getting appropriate surveillance for liver cancer?

6. 4. Linkage to Care Assessment of stage/risk Treatment Surveillance/monitoring

7. Prevention – Working notes • Vaccination • Education • Identification of high risk populations • Surveillance of at-risk populations • Access to care (to reduce risk of progression) • Appropriate assessment • Retention in care • Diagnosis, treatment • Develop sample information for use by blood banks • Plasma donations

8. Notes – Random order • HCV/HBV Diagnosis as prevention • Vaccination • ID High risk • Treatment of risk factors that are modifiable • Prevent downstream HCC • Modify risk – reduces but doesn’t eliminate • Existing burden – imminent risk • Early identification • Increase therapeutic options • Monitoring, surveillance of at risk populations • Educating primary and other care givers on what to look for

9. Notes (cont.) • ID Groups at risk • B, C, alcohol, obesity… • Modify risks • Access to care • Reduce unsafe lifestyle risks • Increase follow up by blook banks to positive plasma • Coffee intake (Starbucks messaging • Early risk assessment • Education of primary caregivers / primary care • Prevention starts with awareness/education • Primary care providers • Public • Universal HBV vaccination • Birth dose – increased advocacy needded • Access to adult vaccine