More Frequent Ultrasound Screening for People at High Risk for Liver Cancer May Be Worth It

NEW YORK (Reuters Health) – Regular ultrasound screening with an interval between six and 12 months or less may lead to earlier detection of hepatocellular carcinoma (HCC) in high-risk patients, according to a study from Taiwan.

Currently, three organizations – the American Association for the Study of Liver Disease, the Asian Pacific Association for the Study of the Liver, and the European Association for the Study of the Liver – advise abdominal ultrasound screening at six-month intervals for high-risk patients. However, adherence to this recommendation has been “inadequate,” the study team says.

To gauge the impact of more frequent ultrasound screening, Dr. Jung-Der Wang with National Cheng Kung University Hospital College of Medicine and colleagues evaluated data on more than 59,000 adults newly diagnosed with HCC (71% men) between 2002 and 2015 who were followed for about 14 years.

Participants were divided into five screening-interval groups: six months (zero-to-six months), 12 months (seven-to-12 months), 24 months (13-to-24 months), 36 months (25-to-36 months), and more than 36 months.

According to the JAMA Network Open report, fewer than half of the patients with HCC underwent ultrasonography within either six or 12 months before diagnosis and there was a significant decreasing trend in the total number of ultrasonographic screens in the three years before HCC diagnosis. This was the case in both men and women.

There was also a “consistent trend showing that the longer the interval between ultrasound examinations, the higher the loss of life expectancy and loss of quality-adjusted life expectancy for both sexes,” the researchers report.

“Compared with no abdominal ultrasonography screening within 36 months before diagnosis, screening six months before diagnosis was associated with an additional 4.6 quality-adjusted life-years (QALYs) for men and 2.4 QALYs for women,” they say.

“Patients with underlying hepatitis B virus infection or cirrhosis had the greatest improvement in life expectancy with shorter screening intervals,” they note. Yet, this group showed only slightly more frequent ultrasound screening than those without these underlying risk factors.

“There is almost no adverse effect for ultrasonography except time and money,” Dr. Wang said in email to Reuters Health.

“Unfortunately, because the development of HCC usually takes longer than one to two decades, many patients with viral hepatitis B or C infection or cirrhosis of liver might feel tired of such examinations after negative results of the initial several years. Then, many of them would consider that they might not be the unlucky one who would later develop HCC and stop the biannual screening ultrasonography,” Dr. Wang added.

“Our finding shows a clear indication of saving life-years and quality of life and clinician can use this knowledge to remind their patients, especially those with viral infection and/or cirrhosis of liver of the importance of regular screening,” Dr. Wang said.

SOURCE: JAMA Network Open, online June 24, 2021.

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