Prioritising viral hepatitis elimination to prevent hepatocellular carcinoma: A public health approach for effective preventive hepatology

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, accounting for about 70-80% of cases globally. The hepatitis B and C viruses (HBV and HCV) account for approximately 70% of all HCC cases worldwide, with variation across geographic regions. While progress has been made in achieving some of the World Health Organization's viral hepatitis elimination targets set for 2030, considerable action is still needed to achieve global viral hepatitis elimination. Although numerous viral hepatitis prevention strategies, including vaccination against HBV, have proven successful, considerable gaps and challenges remain in their implementation. Likewise, monitoring for additional risk factors for HCC continues to be insufficient. This is particularly important given that the burden of viral hepatitis is further compounded by the high and rising prevalence of steatotic liver disease (formerly called fatty liver disease), a growing global concern and a major HCC driver. A more comprehensive approach to HCC prevention is critical and we propose an evolving narrative which emphasises an expanded understanding of “preventive hepatology” as a framework. Preventive hepatology recognises that the growing burden of liver cancer, mainly HCC, can be effectively addressed through the prevention and treatment of viral hepatitis, with additional, targeted preventive measures being applicable for populations at risk, through screening and surveillance. A more holistic approach to HCC prevention should include primary prevention strategies for the early detection and timely treatment of viral hepatitis and steatotic liver disease. It should also include HCC surveillance among people living with chronic viral hepatitis infection, particularly those living with cirrhosis, those cured of HCV, and the management of additional risk factors associated with other HCC aetiologies.