Expert: Patients with cirrhosis have a ‘sufficiently high risk’ for liver cancer
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Screening for hepatocellular carcinoma is critical in high-risk patients, according to a presentation at GUILD conference 2022.
“The incidence of liver cancer is increasing several-fold, particularly within the South and the West. ... At the same time that the incidence is going up, so too is the mortality, nearly two-fold,” Elliot B. Tapper, MD, associate professor of medicine at the University of Michigan, said. “When you look underneath the hood to ask whom this is happening to, you can see some very important clues to tell us a little bit about where this disease is going.”
Modeled projections through 2030 indicate that while liver cancer numbers have and will increase among patients aged 65 to 84 years, younger groups will see less incidence of HCC over time. Further, the incidence of HCC is “several-fold” higher among men compared with women.
While conventional risk factors for liver cancer — fibrosis stage and active hepatitis C and hepatitis B status — are still prevalent, Tapper noted that cirrhosis and fatty liver disease have emerged as dominant 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 a family history of liver cancer,” Tapper said, advising attendees to follow recent practice guidance from AASLD. “The age cut-offs are different depending on epidemiologic factors, which are proxies for how long you have had hepatitis B. But in a word, we are interested in cirrhosis and viral hepatitis history.”
When it comes to screening modalities, ultrasound is quite popular, although sensitivity (about 50%) and specificity for the detection of early liver cancer is lacking. Further, troublesome factors, such as operator-dependence, inconvenience and variability from patient to patient, decrease scan quality and limit its performance. Blood-based biomarker tests continue to be studied for use in screening at-risk populations.
“The people who do not benefit from screening are those who are at low risk of liver cancer: that is, people who do not have cirrhosis; people who just have non-cirrhotic fatty liver disease,” Tapper concluded. “While it is not true right now, it may become clear in the future that several years out from being cured of your hepatitis C you would have a lower risk, but right now, as long as you have cirrhosis, you will have a sufficiently high risk for liver cancer and therefore should be considered for screening.”
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Tapper E. Presentation: HCC Surveillance: Who, How and Anticipated Benefits. Presented at: GUILD 2022; Feb. 20-23, 2022 (hybrid meeting).
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