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

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 HIVAIDS HCC risk Advanced liver disease Fibrosis Cirrhosis ESLD HCC Transplant HBV HCV NASH Obesity Diabetes, etc. 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