Overcoming disparities in hepatocellular carcinoma outcomes in First Nations Australians: a strategic plan for action

Overcoming disparities in hepatocellular carcinoma outcomes in First Nations Australians: a strategic plan for action E very year, about 1800 Australians die of hepatocellular carcinoma (HCC), the most common type of primary liver cancer. 1 Aboriginal and Torres Strait Islander peoples of Australia (hereon respectfully referred to as First Nations Australians) are 2.5 times more likely to develop HCC and 1.4 times more likely to die from HCC than non-Indigenous Australians. 2 First Nations Australians with HCC have a 9% five-year survival rate compared with 23% for non-Indigenous Australians, 2 and are half as likely to be diagnosed with early-stage HCC and receive curative therapy. 2 This is driven by First Nations Australians being adversely affected by social, cultural and commercial determinants of health stemming from colonisation, racism and remoteness.3 Chronic liver disease is the key cause of HCC and most chronic liver disease is preventable and treatable.4,5 First Nations Australians shoulder a disproportionate burden of chronic liver disease (Box 1).6 Alcoholrelated liver disease is a leading cause of HCC in all Australians, including First Nations Australians.2,7,8 The prevalence of hepatitis B and C is two-to three-fold higher in First Nations Australians compared with non-Indigenous Australians.2,5 The most prevalent hepatitis B genotype in remote First Nations communities (genotype C4) is associated with more aggressive liver disease and increased HCC risk compared with other genotypes.9,10 Obesity and type 2 diabetes, both leading risk factors for metabolic-associated fatty liver disease, are twice as common in First Nations Australians than in non-Indigenous Australians.3 Importantly, First Nations Australians are more likely to have multiple cofactors driving liver injury, 2 warranting a multipronged approach to HCC prevention. MethodsThe two lead authors of this article, one First Nations Australian and one non-Indigenous Australian, established a nationally representative, diverse group of four First Nations Australian and 14 non-Indigenous Australian clinical and research leaders in the fields of HCC and chronic liver disease for the project.All authors have expertise in the provision of regional or remote models of HCC or chronic liver disease care, or both.First, an initial two-hour virtual meeting was held, where authors shared their thoughts and responses to two main topics: i) identifying unmet needs in prevention, diagnosis and treatment of HCC in First Nations Australians; and ii) identifying opportunities to address these unmet needs.All authors shared key evidence and their experiences and perspectives, representing the differing epidemiology, health resourcing, policy and legislative contexts across all Australian states and territories.From this discussion, the lead authors developed a list of eight key action items using a positive, evidencebased approach that prioritised First Nations-led interventions and models of care.The aim was to retain action items that had 100% agreement across the author group; all eight action items were ratified by all authors.

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