ideasIdea
Treat everyone with chronic hepatitis B to prevent liver cancer
Hepatitis B causes most liver cancer worldwide, and cheap tablets suppress it. Treating everyone infected, not just those with liver damage, would prevent many cancers.
WHO's 2024 guidelines broadened treatment eligibility, and generic tenofovir costs under $30 a year. Propose national test-and-treat-all HBV programmes with simplified monitoring and hepatocellular carcinoma incidence in treated cohorts as the outcome.
Hypothesis
Treat-all reduces HCC incidence by at least half over ten years in treated adults compared with eligibility-restricted treatment.
Rationale
Viral load predicts HCC (REVEAL cohort); antivirals reduce HCC in cirrhotics; extension to all is logical and cheap.
What would test it
Stepped rollout in high-prevalence countries with registry linkage and cost-effectiveness modelling.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
8
Bottlenecks it attacks
- Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.
- Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.