Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: A 16-year population-based study

Abstract

Several published articles have examined the question of whether screening HBsAg-positive carriers for early detection of liver cancer is beneficial and prolongs survival rate. [5][6][7][8][9][10][11][12][13][14][15] However, HBsAg-positive carriers involved in these studies have not been followed up long enough to determine whether prolonged survival time is truly a benefit of early detection or is a result of lead time bias from detection of tumors when they were smaller in size. In addition, these previous studies include in their survival analysis only cases that are detected early and do not include control patients who had not been screened before diagnosis of HCC for comparison. Natives of Alaska have been shown to have a high rate of HBV infection and HCC. 16,17 Serologic surveys of Alaska natives in the 1970s identified several hundred carriers of HBsAg. A retrospective study of stored serum samples in carriers who were diagnosed with HCC showed that alpha-fetoprotein (AFP) levels were elevated as long as 3 years before clinical presentation of HCC in several patients. 18 Between November 1982 and December 1987, over 53,000 Alaska natives were screened for HBV seromarkers and a hepatitis B vaccine was administered to all seronegative persons and all newborns. 19 In addition, we began a program to follow-up all HBsAg-positive carriers, including those identified previously, with semiannual determinations of AFP levels to determine if HCC could be detected at an early, potentially resectable, stage. In a preliminary report written 3 years after the start of this program, 4 patients were detected at a potentially resectable stage. 20 However, this report could not address any benefits of screening in regard to long-term survival. This article presents the 16-year longitudinal follow-up of 1,487 identified HBsAg-positive carriers tested semiannually with AFP determinations. PATIENTS AND METHODSPatients. A total of 1,487 patients chronically infected with HBV (HBsAg-positive for 12 months or longer) were identified. These carriers resided in 126 communities; most are isolated villages without road access. All carriers identified were contacted by mail, informed that they were at increased risk of developing HCC, and urged to have blood drawn every 6 months by their local Community Health Aide at the village clinic or at the nearest hospital. Every 6 months a reminder letter was sent to all carriers, to the Community

Effect of surveillance for hepatocellular carcinoma on tumor staging and treatment decisions in Egyptian patients

“…Therefore, the current available data seem to indicate that implementing screening programs improves the outcome for patients in terms of increasing the chance of successful treatment and prolonging survival [20,21,24,32]. In countries where HCC is of low prevalence, screening for HCC may not be cost-effective.…”

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

“…AFP is the most widely studied screening test for HCC [141][142][143]. However, it is known that a significant proportion of small HCCs (e.g., B3 cm) do not secrete AFP to achieve a diagnostic level [142].…”

Preclinical and post-treatment changes in the HCC-associated serum proteome

“…However, symptoms seldom develop in patients with these small tumours with the result that relatively few patients are suitable for such treatment options. There is, therefore, considerable interest in presymptomatic detection by surveillance of high-risk groups (Liaw et al, 1986;Colombo et al, 1991;Chalasani et al, 1999;McMahon et al, 2000;Mok et al, 2005). Although there is no conclusive evidence (in terms of reduction of disease-specific mortality) that surveillance is effective, it is nonetheless widely practiced (Chalasani et al, 1999) and there is no doubt that such programmes do result in the detection of small tumours (Chalasani et al, 1999;Mok et al, 2005).…”