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Published on: September 30, 2021
Utilization of screening for hepatocellular carcinoma in the United States
Jessica A Davila1, Allan Weston, Walter Smalley
1Section of Health Services Research, Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA. jdavila@bcm.tmc.edu
Insights
Hepatocellular carcinoma (HCC) screening is underutilized, with less than a third of high-risk patients receiving it. Suboptimal screening practices, often limited to alpha-fetoprotein tests, were too infrequent to impact patient outcomes.
Area of Science:
- Hepatology
- Oncology
- Public Health
Background:
- Hepatocellular carcinoma (HCC) screening is recommended for high-risk individuals.
- However, the actual utilization and factors influencing HCC screening remain poorly understood.
Purpose of the Study:
- To investigate the utilization rates and determinants of HCC screening in a patient cohort.
- To assess the impact of screening on mortality risk.
Main Methods:
- Retrospective analysis of 157 HCC patients diagnosed between 1998-2003 across three medical centers.
- Data collected included screening receipt, demographics, risk factors, liver disease severity, tumor characteristics, therapy, and survival.
- Multivariable logistic regression and Cox proportional hazards models were used to analyze determinants of screening/therapy and the effect of screening on mortality.
Main Results:
- Only 28% of HCC patients received any screening prior to diagnosis.
- Screened patients were younger and more likely to have Hepatitis C (HCV) or alcoholic liver disease.
- Receipt of therapy was associated with tumor board presentation and oncology referral.
Conclusions:
- Screening for HCC is significantly underutilized, with many patients receiving only alpha-fetoprotein testing.
- Current screening practices are too suboptimal to demonstrate a significant impact on patient outcomes.
- Further research is needed to improve screening adherence and effectiveness in high-risk populations.
Background:
Screening for hepatocellular carcinoma (HCC) has been recommended for patients at high-risk of developing HCC. Yet, the utilization and determinants of screening remain unclear.
Methods:
All patients diagnosed with HCC at 3 medical centers during 1998 to 2003 were identified. Information regarding receipt of HCC screening, demographics, risk factors, liver disease severity, number of HCC lesions, therapy, and date of death was abstracted from medical records. Multivariable logistic regression models were conducted to evaluate determinants of HCC screening and therapy. Cox proportional hazards models were developed to assess the effect of screening on risk of mortality.
Results:
We identified 157 patients diagnosed with HCC. The majority of patients were <65 years (62%), white (59%), had a single mass (42%), and a Child-Pugh-Turcotte score B (41%). Approximately, 28% (n=44) received at least one possible screening test (36% alpha-fetoprotein only, 23% abdominal ultrasound only, 7% computed tomography only; 34% had more than one test). Screened patients were younger [odds ratio (OR)=2.70; 95% confidence interval (CI): 1.22-5.99) and were more likely to have underlying HCV (OR=2.91; 95% CI: 1.36-6.23), or alcoholic liver disease (OR=4.20; 95% CI: 1.89-9.35). The only predictors of receipt of therapy were presentation at tumor board conference (OR=2.85; 95% CI: 1.42-5.72) and documented referral to oncology (OR=2.33; 95% CI: 1.10-4.94).
Conclusions:
Less than one-third of patients who were diagnosed with HCC received screening before their diagnosis, and of those a large proportion received an alpha-fetoprotein test only. In this study, the use of screening was too suboptimal to be expected to affect outcomes.
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