Patients with cirrhosis have a ‘sufficiently high risk’ of liver cancer
February 23, 2022
2 minute read
Tapper E. Presentation: HCC Surveillance: Who, How and Expected Benefits. Presented at: GUILD 2022; February 20-23, 2022 (hybrid meeting).
Disclosures: Tapper reports research support from Ambys, Gilead, Novo Nordisk and Valeant.
Screening for hepatocellular carcinoma is essential in high-risk patients, according to a presentation at the GUILD 2022 conference.
“The incidence of liver cancer is multiplied by several, especially in the South and West. … At the same time as the incidence increases, so does the mortality, almost doubling,” Elliot B Type, MARYLAND, associate professor of medicine at the University of Michigan, said. “When you look under the hood to ask who this is happening to, you can see some very important clues to tell us a bit about where this disease is going.”
Modeled projections to 2030 indicate that while the number of liver cancers has increased and will increase in patients aged 65 to 84, younger age groups will see less incidence of HCC over time. In addition, the incidence of HCC is “several times” higher in men than in women.
While the conventional risk factors for liver cancer — stage of fibrosis and active hepatitis C and hepatitis B status — are still prevalent, Tapper noted that cirrhosis and fatty liver disease have become major drivers of disease.
“Screen for liver cancer every 6 months and pay attention to the dominant risk factors: namely age, biological sex, history of viral hepatitis and family history of liver cancer,” said Tapper, advising participants to follow the recent practical advice of the AASLD. “The age thresholds are different depending on epidemiological factors, which are indicators of how long you’ve had hepatitis B. But in a nutshell, we’re looking at history of cirrhosis and viral hepatitis.”
As for screening modalities, ultrasound is quite popular, although the sensitivity (about 50%) and specificity for detecting early liver cancer is lacking. In addition, hindering factors, such as operator dependency, inconvenience, and patient-to-patient variability, decrease the quality of the analysis and limit its performance. Blood biomarker tests continue to be studied for use in screening populations at risk.
“The people who don’t benefit from screening are those who have a low risk of liver cancer: that is, people who don’t have cirrhosis; people who just have non-cirrhotic fatty liver disease,” Tapper concluded. “Although this is not true at this time, it may become clear in the future that several years after being cured of your hepatitis C, you would have a lower risk, but at this time, as long as you have cirrhosis , you will have sufficiently high risk of liver cancer and should therefore be considered for screening.