6%) of the 10 769 commune health stations which provide health services in Viet Nam found that liver cancer is the most common cause of cancer RAD001 death in Viet Nam,6 accounting for 27.1% of cancer deaths (31.04% in men and 19.91% in women).

It is thought that over 90% of these liver cancer deaths reflected the high prevalence of HBV infection in Viet Nam.23 Alcohol and HCV infection are other likely contributors to this high rate of liver cancer. In one study of patients diagnosed with HCC, the majority (85%) had evidence of CHB; almost one in seven patients had evidence of HCV.24 For prevention of liver cancer in Viet Nam, the first long-term focus should be HBV vaccination, thus effecting primary prevention of all liver cancers that are related to this virus. In addition, it will be important to use the best available treatments to profoundly suppress HBV and HCV in the chronically infected to lessen HCC risk. It will also be important to address alcoholic liver disease well before it reaches the stage that can

lead to cancer. There are many challenges that exist in Viet Nam related to providing the type of total integrated approach to liver disease that could substantially decrease both morbidity and mortality. Although 70–75% of Viet Nam’s 84 million people dwell in rural and mountainous regions where medical care is substantially limited, almost all of the 10 769 communes have a health center which provides both primary health care and preventive health-care activities,25 a potentially valuable resource for addressing liver disease. Providing the health centers with simple accurate guides on proper screening and vaccination procedures Olaparib nmr for HBV, screening medchemexpress for HCV, and treatment for those with CHB and CHC could guide them to proper care of liver disease patients. Because these commune health centers already have information flowing to and from the Ministry of Health, a national mandate to improve liver disease services could efficiently reach the local commune level. It will also

be important to enlist private health-care providers as in some areas there are more private providers than public ones.26 The non-profit health organizations that provide health care in Viet Nam are also valuable resources. All provinces and most communes (95.7%) have a Red Cross Society branch that provides free health checks for the poor and other vulnerable groups, including children, the elderly, and women,25 so enlisting their help in the campaign against liver disease might be invaluable. Re-use of contaminated needles, syringes, and inadequately sterilized medical equipment is another major challenge that must be addressed. Recent Vietnamese studies have identified as major risk factors for HBV infection a history of hospitalization and of acupuncture4 as well as a history of surgery.9 HCV prevalence is particularly high in patients on maintenance hemodialysis (54%) and those with hemophilia (29%).