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Screening for Liver Cancer in Patients With Hepatitis C Virus Infection and Cirrhosis FREE

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The full report is titled “Utilization of Surveillance for Hepatocellular Carcinoma Among Hepatitis C Virus–Infected Veterans in the United States.” It is in the 18 January 2011 issue of Annals of Internal Medicine (volume 154, pages 85-93). The authors are J.A. Davila, L. Henderson, J.R. Kramer, F. Kanwal, P.A. Richardson, Z. Duan, and H.B. El-Serag.

Ann Intern Med. 2011;154(2):I-36. doi:10.7326/0003-4819-154-2-201101180-00002
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What is the problem and what is known about it so far?

Patients with cirrhosis are at higher risk for a form of cancer called hepatocellular carcinoma (HCC) than persons who have normal liver function. Because treatments for HCC are more effective when the cancer is detected early, patients with cirrhosis should have yearly testing to help detect HCC. Screening can be done with a blood test or ultrasonography. Patients infected with hepatitis C virus (HCV) often develop cirrhosis, but it is not known whether screening for HCC in these patients is being done as it should be.

Why did the researchers do this particular study?

Learning whether patients at risk for HCC are being screened as recommended might help identify areas for improving care.

Who was studied?

128,505 patients with HCV infection treated in the Veterans Affairs health care system from 1998 to 2005; approximately 10% had cirrhosis.

How was the study done?

Electronic administrative records were used to identify patients with HCV infection and cirrhosis. Using these records, the researchers assessed whether screening tests to detect HCC (ultrasonography or blood tests) were done during the 5-year study. Testing done 2 years in a row was considered evidence of routine screening, whereas at least 1 test that was not routinely done was considered inconsistent screening. No screening was when neither ultrasonography nor a blood test to detect HCC was done during the 5-year study.

What did the researchers find?

Routine screening for HCC was found in only 12% of patients with HCV infection and cirrhosis. Inconsistent screening was found in 58.5%. Almost 30% of patients with cirrhosis had no screening tests done. Patients with more medical problems, psychological ailments, or more advanced liver disease were less likely to have had routine screening.

What were the limitations of the study?

Because the researchers were unable to review the clinical charts of the patients, they could not tell whether a doctor recommended or ordered a screening test that was never done.

What are the implications of the study?

Only few veterans with HCV infection and cirrhosis are having routine screening for HCC, despite being at increased risk for this type of cancer. More research is needed to find ways to improve the rate of screening in high-risk patients.





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