HCC Prevention & Diagnosis Country Data

We have developed an interactive data map to view and compare liver cancer information from across Europe. Click on a country to see the available data.

Austria
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 45-65% Percentage of pregnant women screened for HBV around 65% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination 65-85% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government and patient organisations. HCV treatment is accessible and the first round of treatment is reimbursed
Awareness campaigns…	about liver disease exist, organised by government about the benefits of HBV vaccination exist, organised by government and medical societies
Awareness level about HCC…	risk factors, of the general public is very poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is very poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 100% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s)
Diagnosis stage	Early stage (stage A)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2 weeks After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 2-3 months
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Belgium
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is abover 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer exist, organised by charities/patient organisations about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	N/A
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and no recall system
Diagnosis stage	Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Bulgaria
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Not known if official organised efforts to vaccinate affected adult populations against HBV HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis exist, organised by medical societies about the benefits of HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is very poor risk factors, of primary care physicians is very poor signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is moderate signs and symptoms, of primary care physicians is moderate
Prevention efforts	Not known if official organised efforts to prevent people from developing metabolic syndrome Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	N/A
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is around 50% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed less frequently than once a year, not known what nonadherence to surveillance most likely due to
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	Not known how soon after a GP referral patients are seen by a specialist doctor Not known how soon after initial referral diagnostic investigations are usually completed After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Not known if diagnosis and staging of HCC managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Croatia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is around 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is 85-95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government, patient organisations, non-governekmental organisations HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver disease, hepatitis and liver cancer exist, organised by government, medical societies, charities/patient organisations about the benefits of HBV vaccination exist, organised by medical societies, government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is poor-moderate risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, patient organisations, non-governmental institutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is around 50% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed every 6 months, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Advanced stage (stage C)/Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	HBV prevalence 0.2-0.7 %, incidence 100 cases per year (on 3.8 mil. population), source Croatian Institute of Public Health, 2023. HCV prevalence 0.5-0.9 %, incidence 150-200 cases per year (on 3.8 mil. population), source Croatian Institute of Public Health, 2023. HCC prevalence 8.5%, incidence 400 cases per year (on 3.8 mil. population), 480 people died of HCC in 2022.; The Report on Causes of Death for 2022. by National Institute for Public Health, published January 16 2024.

Cyprus
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV is not known. Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known. Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis, liver disease and liver cancer exist, organised by medical societies about the benefits of HBV vaccination exist, organised by ,government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is moderate risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is stigma associated with HBV infection, HCV infection, but not with liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist No data on frequency of HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis). Nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and no recall system
Diagnosis stage	Terminal stage (stage D)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-3 months After initial referral diagnostic investigations are usually completed within 4-6 months After staging and diagnosis treatment usually starts within 4-6 months
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Czech Republic
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Not known if official organised efforts to vaccinate affected adult populations against HBV exist. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by charities/patient organisations, government, pharmaceutical industry, medical societies about the benefits of HBV vaccination not known
Awareness level about HCC…	risk factors, of the general public is moderate risk factors, of primary care physicians is very poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Not known if official organised efforts to prevent people from developing metabolic syndrome exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease but not with HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Denmark
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is less than 45% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government and patient organisations HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease and HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	There is stigma associated with HCV infection, liver disease but not with HBV infection and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to patients not attending appointments
Diagnosis stage	N/A
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Finland
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	No data on coverage (3rd dose) for childhood HBV vaccination No data on percentage of pregnant women screened for HBV No data on percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination Official organised efforts to vaccinate affected adult populations against HBV do not exist HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis exist, organised by government, charities/patient organisations, medical societies about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is very good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, by government and non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is stigma associated with HCV infection, HBV infection, no data on liver disease and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, no data on adherence HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence: Acute: 0,07/100 000, Chronic: 2,89/100 000 (source) “25,000–30,000 carriers of HCV (0.5% of the population)” 12.7.2021 Duodecim

France
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Not known if official organised efforts to vaccinate affected adult populations against HBV exist Not known if HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis and HBV vaccination exist, organised by government
Awareness level about HCC…	risk factors, of the general public is poor-moderate risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	No stigma associated with HCV infection, liver disease, HBV infection and HCC.
HCC surveillance	Not known if county-specific guidelines that recommend the surveillance of HCC exist Not known hlow frequently HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s)
Diagnosis stage	N/A
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor after 6 months After initial referral diagnostic investigations are usually completed within 4-6 months After staging and diagnosis treatment usually starts within 2-3 months
Multidisciplinary approach	Diagnosis and staging of HCC is sometimes managed by a multidisciplinary medical team Not known if initial treatment plan after diagnosis is designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Germany
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Greece
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 65-85% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is 65-85% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver disease and HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is moderate risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption exist organised by government
Stigma	No stigma associated with HCV infection, liver disease, HBV infection and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to patients not attending appointments
Diagnosis stage	Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Hungary
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Not known if official organised efforts to vaccinate affected adult populations against HBV exist HCV treatment is accessible and reimbursed
Awareness campaigns…	N/A
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is very poor signs and symptoms, of primary care physicians is good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, orgnaised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	Not known if there is stigma associated with HCV infection, liver disease, HBV infection and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist. Adherence unknown. Frequency of HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is not known, not known what, nonadherence to surveillance is most likely due to.
Diagnosis stage	N/A
Timings related to diagnosis	Not known how soon after a GP referral are patients seen by a specialist doctor. Not known how soon after initial referral diagnostic investigations are usually completed. Not known how soon after staging and diagnosis treatment starts.
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	The prevalence of HBV infection in the Hungarian general population is 0,5–0,7%."" Horváth et al. 2018: A hepatitis B- és D-vírus-fertőzés diagnosztikája, antivirális kezelése. Magyar konszenzusajánlás. http://akademiai.com/doi/abs/10.1556/650.2017.30689.; incidence (reported, acute cases only 2018-2022): 0.4-0.1 / 100,000 inhabitants; https://www.antsz.hu/data/ HCV incidence (reported, acute cases only 2018-2022): 0.05-0.2 / 100,000 inhabitants; https://www.antsz.hu/data/ HCC incidence: 1362 new cases in 2020 https://stat.nrr.hu

Ireland
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Italy
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is around 85% Percentage of pregnant women screened for HBV is around 85%. Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95%. Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis and liver disease exist, organised by government, charities/patient organisations, medical societies about the benefits of HBV vaccination exist, organised by government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor-moderate signs and symptoms, of at-risk populations is poor-moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor-moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, non-governmental insitutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, non-governmental insitutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and possibly less with HCC (50% answered yes)
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is carried out every 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Early (stage A) to Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	HBV incidence: 153 cases/year (Source: Italian institute of health - epidemiology for public health) HCV Incidence: 51 cases/year (Source: Italian institute of health - epidemiology for public health) The average annual incidence rates of HCC per 100,000 persons were 14.6 (men) and 3.5 (women) (Source: The Italian Cancer Registries' Collaborative Group. Cancers (Basel). 2022 Dec 14;14(24):6162. doi: 10.3390/cancers14246162.); HCC mortality rate 7% (data: AIOM)

Latvia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV is around 95%. Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is around 95%. Official organised efforts to vaccinate affected adult populations against HBV do not exist HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis, liver cancer and liver disease exist, organised by government, charities/patient organisations, medical societies about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is moderate signs and symptoms, of at-risk populations is poor-moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, non-governmental insitutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There may be stigma associated with HBV infection and HCV infection (50% answered yes) but not with liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is carried out every 6 months,, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is almost always managed by a multidisciplinary medical team Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	Prevalence of HBV in Latvia is 306 and incidence is 19 in 2022. (https://www.spkc.gov.lv/lv/virushepatiti) Prevalence of HCV in Latvia is 1019 and incidence is 29 in 2023. (https://www.spkc.gov.lv/lv/virushepatiti) Prevalence of HCC in Latvia is 193 and incidence is 71 in 2021. (https://statistika.spkc.gov.lv/pxweb/lv/Health/); HCC mortality ~200/ year (www.spkc.gov.lv)

Lithuania
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV is 85-95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is 85-95% Official organised efforts to vaccinate affected adult populations against HBV do not exist HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis exist, organised by medical societies about the benefits of HCV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	There is stigma associated with HCV infection, HBV infection, liver disease. Not known for HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist. HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	N/A
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks Not known how soon after staging and diagnosis treatment usually starts
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Netherlands
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is around 85% Percentage of pregnant women screened for HBV is around 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Not known if official organised efforts to vaccinate affected adult populations against HBV exist. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer and hepatitis exist, organised by charities/patient organisations, government, pharmaceutical industry, medical societies about the benefits of HBV vaccination exist, organised by government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is very poor-poor risk factors, of primary care physicians is moderate signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor-moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist organised by government, charities/patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist by government, charities/patient organisations, non-governmental institutions
Stigma	There is stigma associated with liver disease but less or none with HBV infection, HCV infection, HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do exist, adherence is 50-75%. HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and no recall system
Diagnosis stage	Early (stage A) to Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2 weeks After initial referral diagnostic investigations are usually completed within 2 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is almost always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is almost always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence 0,2% of the general population Estimated HCV prevalence is 30.000 cases overall; estimated HCV incidence is 0,1 % Between 2009 and 2016, HCC incidence increased from 2.94 to 3.69 per 100,000 person years based on the RESR. A significant improvement occurred in survival of all patients with HCC within the period 2009–2016 with a 1-year survival of 40, 41, 50 and 46% in the consecutive 2-year periods, a 3- year survival of 20, 23, 27 and 27% and a 5- year survival of 14, 17 and 21% (https://www.sciencedirect.com/science/article/abs/pii/S0959804920303919)

Poland
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Portugal
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is 85-95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by government, medical societies about the benefits of HBV vaccination exist, organised by government, medical societies
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is very poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, non-governmental institutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease but not with HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4-6 months After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is sometimes managed by a multidisciplinary medical team Initial treatment plan after diagnosis is sometimes designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence: Chronic: 0,5 cases/100 000 residents (2021), Acute: 0,1 cases/100 000 residents (2021) (https://www.dgs.pt/) HCV prevalence: Chronic: 0,1 cases/100 000 residents (2021), Acute: 0,4 cases/100 000 residents (2021) (https://www.dgs.pt/) Incidence for liver cancer 2.5%, 5-year prevalence for liver cancer 0.97 per 100 000 residents (https://gco.iarc.who.int/), Mean annual mortality rate of HCC 5.2/100, 000 residents (2010-2017) (Silva, Mario Jorge ; Simoes, Guilherme ; Saraiva, Rita Catarina et al. / Epidemiology of hepatocellular carcinoma in Portugal. In: Journal Of Hepatology. 2022 ; Vol. 77. pp. S211-S211.); Mortality 4.8% (https://gco.iarc.who.int/)

Romania
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination not known Official organised efforts to vaccinate affected adult populations against HBV exist, organised by patient organisations No data on HCV treatment
Awareness campaigns…	about hepatitis and liver cancer exist, organised by charities/patient organisations, medical societies about the benefits of HCV vaccination exist, organised by government, charities/patient organisations, medical societies
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, , organised by non-governmental institutions
Stigma	There is stigma associated with HCV infection, HBV infection and HCC. No data on liver disease.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adharence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed once a year, nonadherence to surveillance most likely due to patients not attending appointments and no recall system
Diagnosis stage	End stage (stage D)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is sometimes managed by a multidisciplinary medical team Initial treatment plan after diagnosis is sometimes designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	Prevalence of chronic HBV (HBsAg+) (%) 5.06 2022 , (Survey/reported https://www.globalhep.org/) Estimated anti-HCV prevalence of 1.4% (95% CI: 1.0–1.9) and a prevalence of chronic HCV infection of 0.9% (95% CI: 0.5–1.2), corresponding to ca 137,000 chronically infected individuals, indicating Romania as a country of low HCV endemicity. (https://www.eurosurveillance.org/) HCC incidence: 3 682, 5 years prevalence: 4 422 (source: Globocan 2022); HCC mortality: 3 495 (source: Globocan 2022)

Serbia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination not known Not known if official organised efforts to vaccinate affected adult populations against HBV HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver disease, liver cancer, hepatitis exist, organised by medical societies about the benefits of HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is very good risk factors, of primary care physicians is very good signs and symptoms, of at-risk populations is very good signs and symptoms, of the general public is very good signs and symptoms, of primary care physicians is very good
Prevention efforts	Not known if official organised efforts to prevent people from developing metabolic syndrome Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	Not known if there is stigma associated with HBV infection, HCV infection, liver disease. No stigma associated with HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 100% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed less frequently than once a year, nonadherence to surveillance is most likely due to patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients are seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Slovakia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination not known Not known if official organised efforts to vaccinate affected adult populations against HBV exist. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by medical societies about the benefits of HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is very good risk factors, of primary care physicians is very good signs and symptoms, of at-risk populations is very good signs and symptoms, of the general public is very good signs and symptoms, of primary care physicians is very good
Prevention efforts	No data on official organised efforts to prevent people from developing metabolic syndrome Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	Not known is there is stigma associated with HBV infection, HCV infection, liver disease or HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 100% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Slovenia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 65-85% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by government, medical societies about the benefits of HBV vaccination exist, organised by medical societies, government
Awareness level about HCC…	risk factors, of the general public is good risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is moderate signs and symptoms, of primary care physicians is good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is no stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed once a year, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-3 months After initial referral diagnostic investigations are usually completed within 2 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence is 0.7%. Incidence in 2020 is 73 patients in 2 million inhabitants or (3.5/100k inhabitants). (From the national institute of health.)HCV prevalence is 0.5%. Incidence in 2020 was 90 new cases (4.3/100k inhabitants). (From the national institute of health.) In 2020, HCC prevalence was less than 1%, meaning the incidence is at 234 new patients. (https://www.onko-i.si/); Mortality is relatively high, standing at approximately 75%. (https://www.onko-i.si/)

Spain
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Sweden
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed/first round of treatment reimbursed
Awareness campaigns…	about liver cancer, exist, organised by government about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor-moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by non-governmental imsitutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, patient advocacy groups, non-governmental imsitutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed once a year, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and patients not attending appointments
Diagnosis stage	End stage (stage D)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-4 weeks After initial referral diagnostic investigations are usually completed within 1-2 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV Prevalence: 250 per 100 000 inhabitants, Incidence: 6.3 per 100 000 inhabitants (Public Health Agency of Sweden (2023)) HCV Prevalence: 300 per 100 000 inhabitants, Incidence: 10.9 per 100 000 inhabitants (Public Health Agency of Sweden (2023), HCC Prevalence: 16 per 100 000 inhabitants, year 2019, Incidence: 7.8 per 100 000 inhabitants, year 2019 (https://pubmed.ncbi.nlm.nih.gov/); mortality rate: 2.73 per 100 000 inhabitants, year 2019 (https://pubmed.ncbi.nlm.nih.gov/)

United Kingdom
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Austria
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 45-65% Percentage of pregnant women screened for HBV around 65% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination 65-85% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government and patient organisations. HCV treatment is accessible and the first round of treatment is reimbursed
Awareness campaigns…	about liver disease exist, organised by government about the benefits of HBV vaccination exist, organised by government and medical societies
Awareness level about HCC…	risk factors, of the general public is very poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is very poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 100% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s)
Diagnosis stage	Early stage (stage A)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2 weeks After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 2-3 months
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Belgium
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is abover 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer exist, organised by charities/patient organisations about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	N/A
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and no recall system
Diagnosis stage	Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Bulgaria
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Not known if official organised efforts to vaccinate affected adult populations against HBV HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis exist, organised by medical societies about the benefits of HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is very poor risk factors, of primary care physicians is very poor signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is moderate signs and symptoms, of primary care physicians is moderate
Prevention efforts	Not known if official organised efforts to prevent people from developing metabolic syndrome Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	N/A
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is around 50% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed less frequently than once a year, not known what nonadherence to surveillance most likely due to
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	Not known how soon after a GP referral patients are seen by a specialist doctor Not known how soon after initial referral diagnostic investigations are usually completed After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Not known if diagnosis and staging of HCC managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Croatia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is around 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is 85-95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government, patient organisations, non-governekmental organisations HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver disease, hepatitis and liver cancer exist, organised by government, medical societies, charities/patient organisations about the benefits of HBV vaccination exist, organised by medical societies, government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is poor-moderate risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, patient organisations, non-governmental institutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is around 50% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed every 6 months, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Advanced stage (stage C)/Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	HBV prevalence 0.2-0.7 %, incidence 100 cases per year (on 3.8 mil. population), source Croatian Institute of Public Health, 2023. HCV prevalence 0.5-0.9 %, incidence 150-200 cases per year (on 3.8 mil. population), source Croatian Institute of Public Health, 2023. HCC prevalence 8.5%, incidence 400 cases per year (on 3.8 mil. population), 480 people died of HCC in 2022.; The Report on Causes of Death for 2022. by National Institute for Public Health, published January 16 2024.

Cyprus
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV is not known. Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known. Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis, liver disease and liver cancer exist, organised by medical societies about the benefits of HBV vaccination exist, organised by ,government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is moderate risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is stigma associated with HBV infection, HCV infection, but not with liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist No data on frequency of HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis). Nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and no recall system
Diagnosis stage	Terminal stage (stage D)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-3 months After initial referral diagnostic investigations are usually completed within 4-6 months After staging and diagnosis treatment usually starts within 4-6 months
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Czech Republic
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Not known if official organised efforts to vaccinate affected adult populations against HBV exist. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by charities/patient organisations, government, pharmaceutical industry, medical societies about the benefits of HBV vaccination not known
Awareness level about HCC…	risk factors, of the general public is moderate risk factors, of primary care physicians is very poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Not known if official organised efforts to prevent people from developing metabolic syndrome exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease but not with HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Denmark
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is less than 45% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government and patient organisations HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease and HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	There is stigma associated with HCV infection, liver disease but not with HBV infection and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to patients not attending appointments
Diagnosis stage	N/A
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Finland
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	No data on coverage (3rd dose) for childhood HBV vaccination No data on percentage of pregnant women screened for HBV No data on percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination Official organised efforts to vaccinate affected adult populations against HBV do not exist HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis exist, organised by government, charities/patient organisations, medical societies about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is very good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, by government and non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is stigma associated with HCV infection, HBV infection, no data on liver disease and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, no data on adherence HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 2 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence: Acute: 0,07/100 000, Chronic: 2,89/100 000 (source) “25,000–30,000 carriers of HCV (0.5% of the population)” 12.7.2021 Duodecim

France
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Not known if official organised efforts to vaccinate affected adult populations against HBV exist Not known if HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis and HBV vaccination exist, organised by government
Awareness level about HCC…	risk factors, of the general public is poor-moderate risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	No stigma associated with HCV infection, liver disease, HBV infection and HCC.
HCC surveillance	Not known if county-specific guidelines that recommend the surveillance of HCC exist Not known hlow frequently HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s)
Diagnosis stage	N/A
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor after 6 months After initial referral diagnostic investigations are usually completed within 4-6 months After staging and diagnosis treatment usually starts within 2-3 months
Multidisciplinary approach	Diagnosis and staging of HCC is sometimes managed by a multidisciplinary medical team Not known if initial treatment plan after diagnosis is designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Germany
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Greece
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 65-85% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is 65-85% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver disease and HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is moderate risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption exist organised by government
Stigma	No stigma associated with HCV infection, liver disease, HBV infection and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to patients not attending appointments
Diagnosis stage	Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	N/A

Hungary
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Not known if official organised efforts to vaccinate affected adult populations against HBV exist HCV treatment is accessible and reimbursed
Awareness campaigns…	N/A
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is very poor signs and symptoms, of the general public is very poor signs and symptoms, of primary care physicians is good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, orgnaised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	Not known if there is stigma associated with HCV infection, liver disease, HBV infection and HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist. Adherence unknown. Frequency of HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is not known, not known what, nonadherence to surveillance is most likely due to.
Diagnosis stage	N/A
Timings related to diagnosis	Not known how soon after a GP referral are patients seen by a specialist doctor. Not known how soon after initial referral diagnostic investigations are usually completed. Not known how soon after staging and diagnosis treatment starts.
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	The prevalence of HBV infection in the Hungarian general population is 0,5–0,7%."" Horváth et al. 2018: A hepatitis B- és D-vírus-fertőzés diagnosztikája, antivirális kezelése. Magyar konszenzusajánlás. http://akademiai.com/doi/abs/10.1556/650.2017.30689.; incidence (reported, acute cases only 2018-2022): 0.4-0.1 / 100,000 inhabitants; https://www.antsz.hu/data/ HCV incidence (reported, acute cases only 2018-2022): 0.05-0.2 / 100,000 inhabitants; https://www.antsz.hu/data/ HCC incidence: 1362 new cases in 2020 https://stat.nrr.hu

Ireland
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Italy
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is around 85% Percentage of pregnant women screened for HBV is around 85%. Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95%. Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis and liver disease exist, organised by government, charities/patient organisations, medical societies about the benefits of HBV vaccination exist, organised by government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor-moderate signs and symptoms, of at-risk populations is poor-moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor-moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, non-governmental insitutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, non-governmental insitutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and possibly less with HCC (50% answered yes)
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is carried out every 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Early (stage A) to Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	HBV incidence: 153 cases/year (Source: Italian institute of health - epidemiology for public health) HCV Incidence: 51 cases/year (Source: Italian institute of health - epidemiology for public health) The average annual incidence rates of HCC per 100,000 persons were 14.6 (men) and 3.5 (women) (Source: The Italian Cancer Registries' Collaborative Group. Cancers (Basel). 2022 Dec 14;14(24):6162. doi: 10.3390/cancers14246162.); HCC mortality rate 7% (data: AIOM)

Latvia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV is around 95%. Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is around 95%. Official organised efforts to vaccinate affected adult populations against HBV do not exist HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis, liver cancer and liver disease exist, organised by government, charities/patient organisations, medical societies about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is moderate signs and symptoms, of at-risk populations is poor-moderate signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, non-governmental insitutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There may be stigma associated with HBV infection and HCV infection (50% answered yes) but not with liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is carried out every 6 months,, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is almost always managed by a multidisciplinary medical team Initial treatment plan after diagnosis designed and discussed by a multidisciplinary medical team most of the time
Incidence and prevalence data	Prevalence of HBV in Latvia is 306 and incidence is 19 in 2022. (https://www.spkc.gov.lv/lv/virushepatiti) Prevalence of HCV in Latvia is 1019 and incidence is 29 in 2023. (https://www.spkc.gov.lv/lv/virushepatiti) Prevalence of HCC in Latvia is 193 and incidence is 71 in 2021. (https://statistika.spkc.gov.lv/pxweb/lv/Health/); HCC mortality ~200/ year (www.spkc.gov.lv)

Lithuania
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV is 85-95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is 85-95% Official organised efforts to vaccinate affected adult populations against HBV do not exist HCV treatment is accessible and reimbursed
Awareness campaigns…	about hepatitis exist, organised by medical societies about the benefits of HCV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome do not exist Official organised efforts to control the accessibility and popularity of alcohol consumption do not exist
Stigma	There is stigma associated with HCV infection, HBV infection, liver disease. Not known for HCC.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist. HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s), patients not attending appointments and no recall system
Diagnosis stage	N/A
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks Not known how soon after staging and diagnosis treatment usually starts
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Netherlands
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is around 85% Percentage of pregnant women screened for HBV is around 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Not known if official organised efforts to vaccinate affected adult populations against HBV exist. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer and hepatitis exist, organised by charities/patient organisations, government, pharmaceutical industry, medical societies about the benefits of HBV vaccination exist, organised by government, charities/patient organisations
Awareness level about HCC…	risk factors, of the general public is very poor-poor risk factors, of primary care physicians is moderate signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor-moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist organised by government, charities/patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist by government, charities/patient organisations, non-governmental institutions
Stigma	There is stigma associated with liver disease but less or none with HBV infection, HCV infection, HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do exist, adherence is 50-75%. HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and no recall system
Diagnosis stage	Early (stage A) to Intermediate stage (stage B)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2 weeks After initial referral diagnostic investigations are usually completed within 2 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is almost always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is almost always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence 0,2% of the general population Estimated HCV prevalence is 30.000 cases overall; estimated HCV incidence is 0,1 % Between 2009 and 2016, HCC incidence increased from 2.94 to 3.69 per 100,000 person years based on the RESR. A significant improvement occurred in survival of all patients with HCC within the period 2009–2016 with a 1-year survival of 40, 41, 50 and 46% in the consecutive 2-year periods, a 3- year survival of 20, 23, 27 and 27% and a 5- year survival of 14, 17 and 21% (https://www.sciencedirect.com/science/article/abs/pii/S0959804920303919)

Poland
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Portugal
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is above 95% Percentage of pregnant women screened for HBV is 85-95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is not known Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by government, medical societies about the benefits of HBV vaccination exist, organised by government, medical societies
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is very poor signs and symptoms, of primary care physicians is poor
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, non-governmental institutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease but not with HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC do not exist HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4-6 months After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is sometimes managed by a multidisciplinary medical team Initial treatment plan after diagnosis is sometimes designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence: Chronic: 0,5 cases/100 000 residents (2021), Acute: 0,1 cases/100 000 residents (2021) (https://www.dgs.pt/) HCV prevalence: Chronic: 0,1 cases/100 000 residents (2021), Acute: 0,4 cases/100 000 residents (2021) (https://www.dgs.pt/) Incidence for liver cancer 2.5%, 5-year prevalence for liver cancer 0.97 per 100 000 residents (https://gco.iarc.who.int/), Mean annual mortality rate of HCC 5.2/100, 000 residents (2010-2017) (Silva, Mario Jorge ; Simoes, Guilherme ; Saraiva, Rita Catarina et al. / Epidemiology of hepatocellular carcinoma in Portugal. In: Journal Of Hepatology. 2022 ; Vol. 77. pp. S211-S211.); Mortality 4.8% (https://gco.iarc.who.int/)

Romania
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 85-95% Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination not known Official organised efforts to vaccinate affected adult populations against HBV exist, organised by patient organisations No data on HCV treatment
Awareness campaigns…	about hepatitis and liver cancer exist, organised by charities/patient organisations, medical societies about the benefits of HCV vaccination exist, organised by government, charities/patient organisations, medical societies
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by patient organisations, non-governmental institutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, , organised by non-governmental institutions
Stigma	There is stigma associated with HCV infection, HBV infection and HCC. No data on liver disease.
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adharence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed once a year, nonadherence to surveillance most likely due to patients not attending appointments and no recall system
Diagnosis stage	End stage (stage D)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 2-3 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is sometimes managed by a multidisciplinary medical team Initial treatment plan after diagnosis is sometimes designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	Prevalence of chronic HBV (HBsAg+) (%) 5.06 2022 , (Survey/reported https://www.globalhep.org/) Estimated anti-HCV prevalence of 1.4% (95% CI: 1.0–1.9) and a prevalence of chronic HCV infection of 0.9% (95% CI: 0.5–1.2), corresponding to ca 137,000 chronically infected individuals, indicating Romania as a country of low HCV endemicity. (https://www.eurosurveillance.org/) HCC incidence: 3 682, 5 years prevalence: 4 422 (source: Globocan 2022); HCC mortality: 3 495 (source: Globocan 2022)

Serbia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination not known Not known if official organised efforts to vaccinate affected adult populations against HBV HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver disease, liver cancer, hepatitis exist, organised by medical societies about the benefits of HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is very good risk factors, of primary care physicians is very good signs and symptoms, of at-risk populations is very good signs and symptoms, of the general public is very good signs and symptoms, of primary care physicians is very good
Prevention efforts	Not known if official organised efforts to prevent people from developing metabolic syndrome Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	Not known if there is stigma associated with HBV infection, HCV infection, liver disease. No stigma associated with HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 100% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed less frequently than once a year, nonadherence to surveillance is most likely due to patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients are seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Slovakia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV not known Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination not known Not known if official organised efforts to vaccinate affected adult populations against HBV exist. HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by medical societies about the benefits of HBV vaccination exist, organised by medical societies
Awareness level about HCC…	risk factors, of the general public is very good risk factors, of primary care physicians is very good signs and symptoms, of at-risk populations is very good signs and symptoms, of the general public is very good signs and symptoms, of primary care physicians is very good
Prevention efforts	No data on official organised efforts to prevent people from developing metabolic syndrome Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	Not known is there is stigma associated with HBV infection, HCV infection, liver disease or HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 100% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed 6 months or more frequently, nonadherence to surveillance most likely due to patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 4 weeks After initial referral diagnostic investigations are usually completed within 4 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is always managed by a multidisciplinary medical team Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	N/A

Slovenia
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination is 65-85% Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed
Awareness campaigns…	about liver cancer, hepatitis, liver disease exist, organised by government, medical societies about the benefits of HBV vaccination exist, organised by medical societies, government
Awareness level about HCC…	risk factors, of the general public is good risk factors, of primary care physicians is good signs and symptoms, of at-risk populations is moderate signs and symptoms, of the general public is moderate signs and symptoms, of primary care physicians is good
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by government Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government
Stigma	There is no stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed once a year, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and patients not attending appointments
Diagnosis stage	Advanced stage (stage C)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-3 months After initial referral diagnostic investigations are usually completed within 2 weeks After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV prevalence is 0.7%. Incidence in 2020 is 73 patients in 2 million inhabitants or (3.5/100k inhabitants). (From the national institute of health.)HCV prevalence is 0.5%. Incidence in 2020 was 90 new cases (4.3/100k inhabitants). (From the national institute of health.) In 2020, HCC prevalence was less than 1%, meaning the incidence is at 234 new patients. (https://www.onko-i.si/); Mortality is relatively high, standing at approximately 75%. (https://www.onko-i.si/)

Spain
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A

Sweden
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	Coverage (3rd dose) for childhood HBV vaccination not known Percentage of pregnant women screened for HBV is above 95% Percentage of new-borns receiving timely (within 24 hours of birth) HBV birth-dose vaccination is above 95% Official organised efforts to vaccinate affected adult populations against HBV exist, organised by government HCV treatment is accessible and reimbursed/first round of treatment reimbursed
Awareness campaigns…	about liver cancer, exist, organised by government about the benefits of HBV vaccination do not exist
Awareness level about HCC…	risk factors, of the general public is poor risk factors, of primary care physicians is poor signs and symptoms, of at-risk populations is poor signs and symptoms, of the general public is poor signs and symptoms, of primary care physicians is poor-moderate
Prevention efforts	Official organised efforts to prevent people from developing metabolic syndrome exist, organised by non-governmental imsitutions Official organised efforts to control the accessibility and popularity of alcohol consumption exist, organised by government, patient advocacy groups, non-governmental imsitutions
Stigma	There is stigma associated with HBV infection, HCV infection, liver disease and HCC
HCC surveillance	County-specific guidelines that recommend the surveillance of HCC exist, adherence is 50-75% HCC surveillance in patients for whom surveillance is recommended (eg. patients with liver cirrhosis) is performed once a year, nonadherence to surveillance most likely due to clinicians not referring patients to screening test(s) and patients not attending appointments
Diagnosis stage	End stage (stage D)
Timings related to diagnosis	After a GP referral patients seen by a specialist doctor within 2-4 weeks After initial referral diagnostic investigations are usually completed within 1-2 months After staging and diagnosis treatment usually starts within 4 weeks
Multidisciplinary approach	Diagnosis and staging of HCC is managed by a multidisciplinary medical team most of the time Initial treatment plan after diagnosis is always designed and discussed by a multidisciplinary medical team
Incidence and prevalence data	HBV Prevalence: 250 per 100 000 inhabitants, Incidence: 6.3 per 100 000 inhabitants (Public Health Agency of Sweden (2023)) HCV Prevalence: 300 per 100 000 inhabitants, Incidence: 10.9 per 100 000 inhabitants (Public Health Agency of Sweden (2023), HCC Prevalence: 16 per 100 000 inhabitants, year 2019, Incidence: 7.8 per 100 000 inhabitants, year 2019 (https://pubmed.ncbi.nlm.nih.gov/); mortality rate: 2.73 per 100 000 inhabitants, year 2019 (https://pubmed.ncbi.nlm.nih.gov/)

United Kingdom
Hepatitis B and C (HBV and HCV) Prevention, Diagnosis, Treatment	N/A
Awareness campaigns…	N/A
Awareness level about HCC…	N/A
Prevention efforts	N/A
Stigma	N/A
HCC surveillance	N/A
Diagnosis stage	N/A
Timings related to diagnosis	N/A
Multidisciplinary approach	N/A
Incidence and prevalence data	N/A