Dear
Editors:
Given
the absence of randomized controlled study data on screening for Hepatoma and
the inherent problem of lead-time bias, would you please share your current
practice pattern in this area? Who are you screening, at what intervals, and by
what methods? Is there a society consensus (eg, AASLD) on this? Thank you
kindly for your time.
PW,
MD
Dear
PW:
Thank
you for your inquiry. Screening for HCC in high-risk patients seems to offer
the best hope for early detection of preclinical or early symptomatic HCC,
which may lead to improved survival.
The
two most commonly used methods for screening are serum AFP and US, which are
most often performed every 6 months. Serum AFP >20 ng/mL has a sensitivity
of 87% and specificity of 31% in hepatitis B endemic countries (1). In our own
study of screening for HCC in patients with chronic hepatitis C and cirrhosis,
the sensitivity and specificity of AFP >20 ng/ml
was
62% and 87%, respectively (2).
Two
consensus conferences recommended screening for HCC in patients with chronic
HBV infection and patients with cirrhosis of all etiologies (3,4). However,
there is no official recommendation for screening for HCC by any agency or
consensus conference in the U.S. and the NCI feels that there is still
insufficient evidence to establish that screening with serum AFP
and/or
US will result in a decrease in mortality (5).
What
do I do? I, and my patients with chronic hepatitis B or ESLD of any cause,
prefer screening. Until there are better data, serum AFP and US every 6 months
seems reasonable.
Emmet
B. Keeffe, MD
References:
1.
Johnson PJ. Clin Liver Dis 2001;5:145
2.
Nguyen et al. Hepatology. Abstract in press.
3. McMahon et al. J Natl Cancer Inst
1991;83:916.
4. Colombo M. J Hepatol 1992;14:401.
5. NCI. www:cancernet.nci.nih.gov