In Viet Nam, liver cancer is the leading cause of cancer deaths, with 90% caused by hepatitis B and C. On World Hepatitis Day, the World Health Organization (WHO) calls for urgent action to remove the barriers to hepatitis elimination and liver cancer prevention.
Early one morning in June, as he was working a night shift at his factory job, Hoang Minh Huy was hit by severe stomach pain.
Initially, he did not pay much attention.
“Our work shifts rotate every three days, and our eating schedule is irregular. So, when our bodies felt off, we thought it was normal - just exhaustion or poor nutrition,” said Mr Hoang, 35, who lives with his wife and four children in Pho Tho Province (formerly Vinh Phuc Province), north-west of Viet Nam’s capital, Ha Noi.
“At first, it was just normal pain. Then it became chest tightness and difficulty breathing. I couldn’t walk and needed help. The doctors classified it as a serious condition.”
Then came the worst news.
“They did an ultrasound and found a mass in my liver. They confirmed a large tumour in my liver.”
Mr Hoang is now being treated for liver cancer at the National Hospital for Tropical Diseases in Ha Noi, which also cares for people with other conditions that result from infectious diseases.
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Facing an uncertain future, liver cancer patient Hoang Minh Huy urges people to get check-ups and seek treatment before it is too late.
Photo: © WHO / Viet Nam
Early screening and diagnosis is key
His cancer is most likely the result of lifelong infection with hepatitis B from his childhood. He said both his mother and grandmother had the same condition, leading him to incorrectly assume it could not be treated.
In fact, hepatitis B is spread mainly through exposure to infected body fluids, including from mother-to-child during birth, which is the most common way it is transmitted.
Mr Hoang tested positive 10 years ago during a health check, but Mr Hoang was not told he needed treatment and regular monitoring.
Now he knows that early diagnosis and treatment, and lifelong management of hepatitis B can dramatically reduce the risk of liver cancer.
Ideally, though, his mother would have been screened for hepatitis B when she was pregnant with him, and her mother before her, so that their babies could have been vaccinated within 24 hours of birth to prevent infection. Both women had hepatitis B.
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Liver cancer patient Hoang Minh Huy, 35, is determined to protect his children from the consequences of hepatitis. Photo: © WHO / Viet Nam
Hepatitis contributes to high liver cancer toll in Viet Nam
Around the world, about 90% of liver cancer is from untreated hepatitis B and C. In Viet Nam, liver cancer is the leading cause of all cancer deaths. Viet Nam ranks among the top 10 countries with the highest liver cancer incidence and mortality in the world.
In Viet Nam, more than 7 million people are estimated to live with hepatitis B and C – in other words, one person in every 15. The condition is more common in adults over 25 years.
Despite substantial efforts, gaps in prevention, early detection and treatment persist.
The gaps are why the theme of World Hepatitis Day, 28 July, this year is Hepatitis: Let’s break it down. Breaking the barriers to hepatitis elimination and liver cancer prevention. On this day, WHO calls for urgent action to dismantle the financial, social and systemic barriers including stigma that stand in the way of hepatitis elimination and liver cancer prevention.
Cost is a significant barrier
Although the cost of hepatitis B treatment and liver cancer surgery is 80% covered by Viet Nam’s social health insurance, Mr Hoang is unable to work, and his family needed to borrow money to help him travel for treatment and to pay for living expenses.
For hepatitis C, people need to pay 50% or more of the cost of their treatment. This can be a very heavy contribution for many people and lead to financial hardship.
A 63-year-old truck driver – Mr Nguyen*, had to borrow money to pay the full cost of hepatitis C treatment as he went directly to the national hospital without a referral from lower-level health facilities. But even if he had been referred from a lower-level hospital, he would still have had to pay half. The patient’s co-payment can be as high as 15 million Vietnamese dong, or about 570 US dollars, more than a month-and-a-half’s salary for an average worker.
The father of two teenagers sought medical care two months ago, after noticing changes to his skin.
Although he is not aware of any stigma, he asked to remain anonymous, as he had not disclosed his diagnosis to anyone.
His advice to others, “If possible, get a health check-up every 6 months to a year. Early detection means early treatment. I found out a bit late, but it’s still treatable. I haven’t reached the stage of liver failure or cancer.”
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At the National Hospital for Tropical Diseases, Dr Nguyen Quang Huy speaks to a Ha Noi truck driver, 63, who is being treated for hepatitis C and advises others to get tested, early. Photo: © WHO / Viet Nam
At the Outpatient Department of the National Hospital for Tropical Diseases, Dr Nguyen Quang Huy sees too many people who have waited too long, and are now suffering with cirrhosis (liver damage that interferes with the organ’s function) or liver cancer.
“The disease is asymptomatic and progresses silently, so patients often do not feel anything. By the time there are symptoms, the disease is in a late stage.
“As well, many people with hepatitis who have had it for 10 or 20 years feel they don’t need to go to the doctor periodically. But I urge people who’ve had hepatitis to continue to have their health monitored.”
The good news is that hepatitis C treatment can cure the condition in three months.
Acting to expand access to diagnosis and care, with donor support
WHO Representative in Viet Nam Dr Angela Pratt said, “Despite being preventable and treatable, the burden of hepatitis for individuals, families and the economy continues to rise.
“The price of hepatitis C treatment in Viet Nam is too high – as the story of Nguyen shows. Too many individuals suffer, with devastating consequences for families, society and the economy.
“We have the hepatitis B vaccine and curative therapy for hepatitis C and proven tools to stop transmission.
“So, World Hepatitis Day is a reminder that we must act now to dramatically expand access to diagnosis and care, so that we can end hepatitis as a public health threat by 2030. Key priorities are ensuring early diagnosis and treatment, increasing social health insurance coverage to reduce the copayment to 20% of the cost of hepatitis C treatment (or less), and routinely screening for hepatitis B during pregnancy.”
“WHO is honoured to support the Government of Viet Nam to expand access to prevention, diagnosis and treatment to save lives and stop liver cancer before it starts.”
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WHO Viet Nam Technical Officer Dr Nguyen Van Thi Thuy speaks to liver cancer patient Hoang Minh Huy in hospital. Photo: © WHO / Viet Nam
In Viet Nam, WHO is working with the Government to strengthen and scale up care, including screening for hepatitis B during pregnancy and, if needed, vaccinating newborn babies, harm reduction, testing and treatment, and widening social health insurance reimbursement so that cost is not a barrier to care.
These priorities were highlighted in a recent WHO-led review, with the generous support of partners and donors including Japan International Cooperation Agency (JICA) and WHO collaborating centres; the Victorian Infectious Diseases Reference Laboratory, Australia, and Kanazawa University, Japan, and the Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention at the Centers for Disease Control and Prevention, USA.
Technology can help overcome barriers to testing and treatment such as access to health care facilities offering these services, people without symptoms not getting tested, long waiting times for test results and cost. With support from the Global Fund, WHO piloted a programme in Viet Nam using innovative technology to improve access to faster hepatitis C diagnosis and treatment.
“Everyone should pay attention to their health”
Now facing an uncertain future, Mr Hoang is determined to protect his three sons, aged 7, 13 and 15, and his daughter, aged 2.
“The doctors advised me to bring my children for check-ups. I want to do that so if there’s a problem, it can be treated early.”
And he has a clear message for others:
“I really want to tell the Vietnamese people, and the global community, not to be careless about seemingly small health issues.
“They can lead to serious consequences, like in my case.
“Everyone should pay attention to their health, get early check-ups, and seek treatment immediately, if they need it.”
*As the truck driver interviewed wished to remain anonymous, he is simply referred to as Mr Nguyen