Dr Pei-Ming Yang discusses Taiwan’s Liver Disease landscape, from Chronic Hepatitis to cancer care – Expert Insights from LEAD 2025, the leading APAC Liver Disease Expert Meeting

The following is a verbatim transcript of an interview conducted with Dr Pei-Ming Yang in June 2025. The transcript has been lightly edited for clarity.

Introduction

I am Dr Pei-Ming Yang, currently an Emeritus Professor of Medicine at the National Taiwan University College of Medicine and also the Chief Executive Officer of the Liver Disease Prevention and Treatment Research Foundation. I am a gastroenterologist specialising in the diagnosis and treatment of liver diseases, and I have been engaged in liver-related research for over 40 years.

What is the prevalence of chronic hepatitis, and how do patients describe its impact on their daily lives?

Chronic liver disease is quite prevalent in Taiwan, especially hepatitis B. Before the implementation of the national free hepatitis B vaccination program for newborns in 1986, the carrier rate of hepatitis B in Taiwan was about 15–20%. These people are now over 40 years old.

The carrier rate of hepatitis C in Taiwan is also relatively high, at around 3–4%. Most of them are also over 40 years old. Other liver diseases include alcoholic liver disease and autoimmune liver diseases.

In contrast, for younger Taiwanese under 40 now, the primary cause of chronic liver disease has become fatty liver, particularly metabolism dysfunction-associated steatotic liver disease, so-called MASLD.

What do you believe are the biggest barriers preventing patients from getting tested early for hepatitis?

Most patients with chronic liver diseases are asymptomatic, so their daily lives, work and mood are usually unaffected. However, MASLD patients often coexist with obesity, leading to more challenges for them trying to lose their weight.

What barriers do patients face in managing hepatitis before any cancer risk arises?

Due to the asymptomatic nature of chronic liver diseases, the general public often lacks strong awareness of the diseases and their potential threats, that is, progression from chronic hepatitis to liver cirrhosis and hepatocellular carcinoma, so-called HCC, and is not proactive in seeking screening for hepatitis B, C, or fatty liver.

In Taiwan, liver disease screening is quite accessible. The government Health Promotion Administration provides free screenings, and non-governmental organisations, especially liver-related foundations, for example, our Liver Disease Prevention and Treatment Research Foundation, frequently organise free liver-disease screening events across the country.

Concerns about being stigmatised – people in Taiwan do not need to worry about being ostracised or having their work and social life affected if they are diagnosed with hepatitis B, C, or other liver diseases.

The Health Promotion Administration (HPA) of the Ministry of Health and Welfare offers free hepatitis B and C screenings for individuals aged 45 to 79, with one screening opportunity available in a lifetime.

For chronic hepatitis B or C patients, the National Health Insurance Administration (NHIA) covers follow-up examination and treatment costs. For non-cirrhotic patients, blood tests such as AST, ALT, and alpha-fetoprotein (AFP), along with abdominal ultrasound, are reimbursed once every 6 months on average. For cirrhotic patients, the surveillance frequency increases to once every 3 months.

Antiviral medications for eligible hepatitis B and C patients are also fully covered. Various HCC treatment options are likewise reimbursed by NHI. In summary, as long as people in Taiwan are willing to participate, HPA and NHIA offer free comprehensive screening, diagnostic, and treatment services for chronic liver diseases.

When patients progress to hepatocellular carcinoma (HCC), what new challenges or fears emerge?

As long as patients with chronic liver diseases can undergo regular follow-up examinations and receive appropriate treatment when necessary, most cases of HCC can be detected at an earlier stage, BCLC stages 0 and A, and the curative treatments, including surgical resection and local ablation, either radiofrequency or microwave, are still feasible.

Conversely, patients who are first diagnosed with advanced HCC are often those who did not receive regular follow-up examinations. It is natural to be afraid of, or even reject, a cancer diagnosis, in both patients and their families.

However, gastroenterologists in Taiwan usually will thoroughly explain available treatment options, procedures and the potential complications to patients. Most importantly, most treatment modalities are reimbursed by National Health Insurance. Proper care to reduce fear in both patients and their families will be provided.

How does Taiwan promote liver disease awareness and ensure early detection and treatment?

In Taiwan, both the HPA of the Ministry of Health and Welfare and the non-governmental liver-related foundations, for example, our Liver Disease Prevention and Treatment Research Foundation, actively instill liver-disease knowledge through various channels to enhance the awareness of people.

This includes information on how viral hepatitis is transmitted, the threat of liver disease, that is, the triad of chronic hepatitis, cirrhosis, liver cell cancer, and the importance of proactive screening, active medical follow-up, as well as early and timely treatment.

Furthermore, because many patients seek medical care from non-gastroenterologist physicians, we also make efforts to educate primary care and non-gastroenterologist physicians on up-to-date liver disease knowledge, enabling them to arrange various appropriate NHI-covered tests and examinations for patients, and even prescribe hepatitis C medications for treatment.

The views and opinions expressed by Dr Pei-Ming Yang are his own views and opinions. Roche disclaims all liability in relation to these views and opinions.

References:

1. National Health Insurance Administration, Ministry of Health and Welfare. Comprehensive safety net for patients with hepatitis C: hepatitis C medicines to be fully covered by NHI [Internet]. 2024 [cited 2025 Nov 25]. Available from: https://www.nhi.gov.tw/en/cp-14307-f6cff-8-2.html
2. Su TH, Wu CH, Liu TH, Ho CM, Liu CJ. Clinical practice guidelines and real-life practice in hepatocellular carcinoma: a Taiwan perspective. Clin Mol Hepatol. 2023;29(2):230-41. doi:10.3350/cmh.2022.0421.
3. National Health Insurance Administration, Ministry of Health and Welfare. National Health Insurance expands the coverage of antiviral medications for hepatitis B. 2021 [cited 2025 Nov 25]. Available from: https://www.nhi.gov.tw/en/cp-340-6903b-8-2.html
4. National Health Insurance Administration, Ministry of Health and Welfare. NHIA encourages early treatments for hepatitis C to prevent liver cancer. 2022 [cited 2025 Nov 25]. Available from: https://www.nhi.gov.tw/en/cp-398-d4514-8-2.html