Hepatocellular carcinoma screening in a hepatitis B virus-infected Korean population

Hepatocellular carcinoma (HCC) screening has been recommended for hepatitis B virus (HBV)-infected individuals in an effort to detect HCC at a sufficiently early stage to provide potentially curative treatments. The study reported here is the first to address the rate of HCC screening use in an HBV endemic area.

Data were collected from 11,147 adults aged ≥40 years who participated in the 2007-2009 Korea National Health and Nutrition Examination Survey and had a valid HBV surface antigen test. Current HCC screening was defined as either receiving an ultrasonography or an α-fetoprotein measurement in the past year. Prevalence estimates were weighted.

The response rate was 78.4 %, and 436 cases of HBV infection were identified. The overall seroprevalence of the HBV surface antigen was 4.1 % [95 % confidence interval (CI) 3.9-4.4 %]. Of the 436 HBV-infected subjects, only 23.2 % (95 % CI 19.5 -27.4 %) were aware that they had been infected, and approximately 27 % (27.1 %; 95 %CI 23.2-to 31.5 %) were up to date with their HCC screening tests; more than half (52.9 %, 95 % CI 48.2-57.5) had never been screened. In a multivariate analysis that included various sociodemographic variables, only self-reported awareness of HBV infection was significantly associated with current HCC screening tests (odds ratio 2.82; 95 % CI 1.64-4.84).

Adoption of HCC screening as a standard practice among HBV-infected Korean adults aged ≥40 years is suboptimal. Evidence-based programs in communities and education for both healthcare providers and HBV-infected persons are needed to improve the implementation of HCC screening in clinical practice.