Asian Pacifc Journal of Cancer Prevention, Vol 14, 2013 6227 DOI:http://dx.doi.org/10.7314/APJCP.2013.14.11.6227 Viral Hepatitis and Liver Cancer in Korea: an Epidemiological Perspective Asian Pac J Cancer Prev, 14 (11), 6227-6231 Introduction Hepatitis B (HB) is a major public health problem in some Asian and Western Pacifc nations. The countries in this area have an estimated 158 million chronic carriers and approximately 300,000 deaths annually, mainly because of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Controlling the infection rate of hepatitis B virus (HBV), a public health threat, has been issued in Korea where HB surface antigen (HBsAg) positivity was relatively high up to 6.6-6.8% in early 1980s (Chae et al., 2009). The public health burden due to cancer, including liver cancer, has also increased in Korea. Chronic infection of 1 Department of Preventive Medicine, Seoul National University College of Medicine, 4 Seoul National University College of Nursing, Seoul, 2 Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, 3 Soonchunhyang University College of Medicine, Cheonan, 5 Department of Preventive Medicine, Gachon University of Medicine and Science, 6 Department of Radiological Science, Gachon University College of Health Science, Incheon, Korea *For correspondence: kyyoo@snu.ac.kr Abstract In the past, hepatitis B virus (HBV) infection was endemic in the general Korean population. The association of HBV infection with the occurrence of liver cancer has been well demonstrated in several epidemiologic studies. While the mortality rates of liver cancer in Korea have decreased steadily over the last decade, the presence of hepatitis B surface antigen (HBsAg) in mothers remains high at 3-4%, and 25.5% of these HBsAg positive mothers are positive for hepatitis B e antigen (HBeAg). HBV infection caused almost a quarter of hepatocellular carcinoma (HCC) cases and one-third of deaths from HCC. These aspects of HBV infection prompted the Korean government to create a vaccination program against HBV in the early 1980s. In 1995, the Communicable Disease Prevention Act (CDPA) was reformed, and the government increased the number of HBV vaccines in the National Immunization Program (NIP), driving the vaccination rate up to 95%. In 2000, the National Health Insurance Act (NHIA) was enacted, which provided increased resources for the prevention of perinatal HBV infection. Then in 2002, the Korean government, in conjunction with the Korean Medical Association (KMA), launched an HBV perinatal transmission prevention program. The prevalence of HBsAg in children had been high (4-5%) in the early 1980s, but had dropped to below 1% in 1995, and fnally reached 0.2% in 2006 after the NIP had been implemented. After the success of the NIP, Korea fnally obtained its frst certifcation of achievement from the Western Pacifc Regional Offce of the World Health Organization (WPRO-WHO) for reaching its goal for HBV control. An age-period-cohort analysis showed a signifcant reduction in the liver cancer mortality rate in children and adolescents after the NIP had been implemented. In addition to its vaccination efforts, Korea launched the National Cancer Screening Program (NCSP) for 5 leading sites of cancer, including the liver, in 1999. As a consequence of this program, the 5-year liver cancer survival rate increased from 13.2% (1996-2000) to 23.3% (2003-2008). The development of both the primary and secondary prevention for liver cancer including HBV immunization and cancer screening has been of critical importance. Keywords: Hepatitis B - vaccination - screening - liver cancer MINI-REVIEW Viral Hepatitis and Liver Cancer in Korea: an Epidemiological Perspective Yohwan Yeo 1 , Jin Gwack 2 , Seokin Kang 3 , Boyeon Koo 4 , Sun Jae Jung 1 , Prakash Dhamala 1 , Kwang-Pil Ko 5 , Young-Khi Lim 6 , Keun-Young Yoo 1 * HBV accounts for almost two-thirds of HCC causes and similar proportion of deaths caused by HCC in Korea, where the liver was the fifth leading site of cancer, accounting for 7.9% of all cancer cases and 15.3% of all cancer deaths ranked in the second common site for the origin of cancer (Korea National Cancer Information Center, 2013). However, liver cancer incidence and mortality have been decreasing for a last decade, as have stomach cancer in men and cervical cancer in women (Jung et al., 2013) (Figure 1). In this review, we focus on the successful implementation of strategies for HBV vaccination and the encouraging trends in the rate of HBV infection and liver cancer mortality in Korea.