Screening for cancer in viral hepatitis

Area of Science:

• Hepatology
• Oncology
• Diagnostic Imaging

Background:

• Hepatocellular carcinoma (HCC) diagnosis is feasible early due to known risk factors and available sensitive, cost-effective tools.
• The long asymptomatic growth phase and solitary mass tendency in many HCC cases facilitate early detection.
• Identifying high-risk populations is crucial for effective screening strategies.

Purpose of the Study:

• To outline recommendations for the early diagnosis and screening of hepatocellular carcinoma (HCC).
• To define high-risk groups eligible for periodic HCC screening.
• To establish screening protocols based on consensus development conferences.

Main Methods:

• Consensus development conferences in Anchorage and Milan identified high-risk groups for HCC.
• Recommendations for screening included serum alpha-fetoprotein (AFP) levels and abdominal ultrasound (US) scans.
• Screening frequencies varied from annually to semi-annually based on specific risk factors like HBsAg carrier status, cirrhosis, and family history.

Main Results:

• High-risk groups identified: chronic HBsAg carriers, patients with cirrhosis, rare metabolic liver diseases, and family histories of HCC.
• Recommended screening for healthy HBsAg carriers: yearly AFP tests.
• Recommended screening for carriers with additional risks (e.g., cirrhosis), or patients with cirrhosis/metabolic conditions: semi-annual AFP and US scans. Annual screening with AFP and aminotransferase levels for HBsAg carriers over 35 or with family history was also suggested.

Conclusions:

• Periodic screening using AFP and US can enable early diagnosis of HCC in at-risk populations.
• Screening protocols should be tailored based on individual risk factors for optimal HCC detection.
• Further recommendations are needed for HBsAg-negative patients with chronic liver disease.