Liver cancer screening: A lifesaving necessity for hepatitis C patients

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Cases of hepatitis C have jumped more than 20 percent in recent years, causing a serious increase in liver disease and cancer.

But new breakthroughs in liver cancer screening could be lifesaving.

More than 3 million people in the United States are living with chronic hepatitis C, and most don’t even feel sick.

But hepatitis C can lead to cirrhosis and liver cancer, and only one in five people who are at risk actually get screened, even though that screening can save lives.

Like many baby boomers, 68-year-old Neil Strassman contracted hepatitis C and didn’t know it. He was diagnosed in 2006.

Eventually, Neil developed liver cancer. He underwent a successful liver transplant in 2012 and is now cancer-free.

“One day, you may be growing a cancer and not know it," Neil said. "And by the time you know it, it’s too late. So, the screenings are really a big deal.”

With liver cancer deaths doubling over the past decade and a huge increase in nonalcoholic fatty liver disease, doctors say lives can be saved if people with hepatitis C are identified and encouraged to be screened for liver cancer.

It requires a blood test and an abdominal ultrasound.

“If Mr. Strassman was found at a more advanced stage, he wouldn’t be around with us today," Dr. Amit Singal said. "I think it really shows you the importance of doing this, because it does save lives.”

Because liver cancer screening is underused, Singal used electronic medical records to identify hepatitis C patients and sent 1,200 letters urging them to get screened. They were able to triple the number of screenings, which is how Neil's cancer was detected.

“This is the future, science and technology coming together to really improve outcomes,” Singal said.

“If you have hepatitis C, get regular screenings," Neil added. "Hopefully, they won’t see anything. But if they do, you’ll be at a stage where it can be cured.”

Singal is also working on a blood test that could eliminate the need for ultrasound to detect early-stage liver cancer. That blood test could be ready in two years.

When liver cancer is at an advanced stage, the life expectancy is one to two years, even with treatment. However, with liver cancer screening, the life expectancy is more than five years, often 10 to 20 years.

REPORT: MB #4445

BACKGROUND: Primary liver cancer, cancer that starts in the liver, accounts for about two percent of cancers in the U.S. In the U.S., primary liver cancer strikes twice as many men as women, at an average age of 67. Primary liver cancer (hepatocellular carcinoma) tends to occur in livers damaged by birth defects, alcohol abuse, or chronic infection with diseases such as hepatitis B and C, hemochromatosis, and cirrhosis. More than half of all people diagnosed with primary liver cancer have cirrhosis, a scarring condition of the liver commonly caused by alcohol abuse. Hepatitis B and C and hemochromatosis can cause permanent damage and liver failure. Liver cancer may also be linked to obesity and fatty liver disease.

DIAGNOSING: Liver cancer is now the fastest-increasing cause of cancer death in the U.S. Incidence rates began rising in the mid-1970s, and they are expected to go up through at least 2030. It’s not only in the U.S. that rates are climbing. A study published in the December 2017 JAMA Oncology? found the incidence of liver cancer increased by 75 percent worldwide between 1990 and 2015. In many countries, liver cancer is among the top four causes of cancer death. A study? found that in the U.S., about 71 percent of all liver cancer diagnoses can be attributable to preventable risk factors, such as cigarette smoking and obesity.

NEW RESEARCH: Amit Singal MD, a Gastroenterologist and Transplant Hepatologist, Associate Professor of Medicine at UT Southwestern Medical Center is using electronic medical records to identify patients at risk for liver cancer. Dr. Singal said, “We send them a letter and we place the orders so the patient can go in and get their ultrasound and blood test done even without ever seeing their provider. We’ve shown that we significantly increase liver cancer screening rates. We evaluated this in a study of nearly 2,000 people and we showed that we increased liver cancer screening rates three times.” He continued, “lives can be saved if the cancer can be found early. It is also important for people with advanced liver disease, from conditions such as hepatitis C, alcohol use, or nonalcoholic fatty liver disease, to be identified and encouraged to be screened for liver cancer. Liver cancer screening requires a simple-to-complete blood test, called alpha fetoprotein, and an abdominal ultrasound.” Patients can be treated with curative treatments like surgical resection or liver transplantation.
(Source: Amit Singal MD)