AASLD 2016: Hepatitis C–Screening for Liver Cancer
It is recommended that people who have cirrhosis should be screened for liver cancer every 6 months. It is known that curing hepatitis C greatly reduces the risk of developing liver cancer in people with cirrhosis, but disease progression and liver cancer can still occur. This is why it is important that people with cirrhosis are screened.
But what is the actual practice of screening patients for liver cancer? A study out of Stanford University found that the actual rate of liver cancer monitoring is alarming. Of 2,916 patients that should be screened every 6 months only 18.9% were screened every 6 months; 17.0% were every 6 to 12 months; 18.6% were every 12 to 24 months; 21.1% were screened every 24 months or over a longer period of time, and 24.5% patients were never screened. The people who were most frequently monitored were those who came into the clinic and those who had decompensated cirrhosis.
Not surprisingly, patients with less frequent screening were diagnosed with more severe liver disease that led to complications that included:
- Portal vein thrombosis (blockage of the vein that carries blood from the intestines to the liver). Portal vein thrombosis excludes people from obtaining a liver transplant.
- Patients were less likely to meet the Milan or University of California of San Francisco criteria for receiving a liver transplant
Alan Franciscus is the Executive Director of the Hepatitis C Support Project and Editor-in-Chief of the HCV Advocate
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Although the incidence of hepatocellular carcinoma continued to rise, researchers discovered the rate of increase slowed between 2010 and 2012, except among high risk subgroups in certain geographic regions.
“This 50 state population-based descriptive study has confirmed the overall rising HCC incidence rates,” Hashem B. El-Serag, MD, MPH, of Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, and colleagues wrote. “However, it is not clear whether the recent slowing down in the overall rates since 2009 represents pending decline rates.”
To determine recent HCC trends in the U.S., including an evaluation of geographic and racial/ethnic differences, El-Serag and colleagues evaluated data from the U.S. Cancer Statistics registry, which covered 97% of the population in 2012.
AASLD 2016: The Liver Meeting
Abstract # 57 Poor Adherence to Hepatocellular Carcinoma (HCC) Surveillance in a U.S. Cohort of 2376 Patients with Chronic Hepatitis C (CHC) and Cirrhosis – Sally A. Tran, et al.
Abstract #1768 Identifying Barriers to Hepatocellular Carcinoma Surveillance in a National Sample of Patients With Cirrhosis – David S. Goldberg, et al.
Abstract #1762 Lack of Compliance to Hepatocellular Carcinoma (HCC) Screening Guidelines in Hepatitis B (HBV) or C (HCV) Virus Co-Infected HIV Patients with Cirrhosis – Sophie Willemse (Netherlands)
The incidence of liver cancer is rising. Several studies looked at how effective the medical profession is doing at screening for hepatocellular carcinoma (HCC).
Conclusion: These three large studies (two in the U.S. and one in the Netherlands) concluded that surveillance is poor.
Editorial Comments: If you have cirrhosis or hepatitis B (with/without cirrhosis), talk to your doctor about HCC screening recommendations. In the U.S., screening includes imaging (ultrasound, CT, or MRI) every 6 months.
Lucinda K. Porter, RN, is a long-time contributor to the HCV Advocate and author of “Free from Hepatitis C” and “Hepatitis C One Step at a Time.” She blogs at www.LucindaPorterRN.com and HepMag.com
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