Liver Cancer – The fastest growing cancer in the US – Screening available but underutilized

First off, a definition: When we talk about liver cancer we talk about a cancer that arises in the liver (medical term hepatoma or hepatocellular cancer) and not a cancer that started somewhere else and then spread to the liver, this is called liver metastasis. Liver cancer (hepatoma) is highly fatal, and death rates in the United States are increasing faster than for any other cancer, having doubled since the mid-1980s. In 2017, it is estimated that the disease will account for about 41,000 new cancer cases and 29,000 cancer deaths in the United States.[i]

What causes liver cancer?

One major factor contributing to the increase is a higher rate of hepatitis C virus (HCV) infection among baby boomers (born between 1945 through 1965). Among this age group, HCV prevalence is approximately 2.6%, a rate 6-fold greater than that of other adults. A rise in obesity and type II diabetes over the past several decades has also likely contributed to the trend. Other risk factors include alcohol, which increases liver cancer risk by about 10% per drink per day, and tobacco use, which increases liver cancer risk by approximately 50%.

Causes of liver cancer (hepatoma, hepatocellular cancer, HCC)

The good news – Early detection improves chances of survival

Although recent advances in management have contributed to improved survival, the overall 5-year survival rate is still <25%. However, patients who undergo hepatoma surveillance have an earlier stage of HCC at diagnosis and may potentially receive curative therapy and have an increased rate of 5-year survival (between 40–70%).

Who should undergo screening (surveillance)?

Surveillance for hepatoma with a liver ultrasound is recommended every 6 months with or without α-fetoprotein (AFP) for patients at high risk for the development of hepatoma, namely patients with chronic hepatitis B or cirrhosis of any etiology.

The bad news – Only 20 % of eligible patients get screened

HCC surveillance is underutilized in many at-risk patients, as reported in a recent meta-analysis that demonstrated that only <20% of patients with cirrhosis undergo surveillance. Specialized hepatology or gastroenterology care results in a significantly higher likelihood of receiving regular surveillance, compared to patients seen by primary care physicians. However, only 20–40% of patients with cirrhosis are followed by gastroenterologists or hepatologists nationally. The most common reason cited for lack of surveillance was failure by physicians to order surveillance tests in patients with cirrhosis. Additional reasons for non-adherence to surveillance include unrecognized liver disease prior to HCC presentation, patient concordance, and limited access to infrastructure and appropriate testing in rural areas.[ii]

A call to action

If you or somebody you know has cirrhosis of the liver, he or she probably should receive the recommended screening by ultrasound of the liver every 6 months. If not, bring it up to your physician or make an appointment with us.

“Patients with cirrhosis must be identified, enrolled in HCC surveillance programs, and recall of patients who already are enrolled in HCC surveillance should be implemented.”[iii]

 

[i] Islami, F., Miller, K. D., Siegel, R. L., Fedewa, S. A., Ward, E. M. and Jemal, A. (2017), Disparities in liver cancer occurrence in the United States by race/ethnicity and state. CA: A Cancer Journal for Clinicians, 67: 273–289. doi:10.3322/caac.21402

[ii] Okoronkwo N, Wang Y, Pitchumoni C, Koneru B, Pyrsopoulos N. Improved Outcomes Following Hepatocellular Carcinoma (HCC) Diagnosis in Patients Screened for HCC in a Large Academic Liver Center versus Patients Identified in the Community. Journal of clinical and translational hepatology. 2017 Mar 28;5(1):31.

[iii] Jou JH, Muir AJ. High Value Care: Hepatocellular Carcinoma Surveillance. Clinical Gastroenterology and Hepatology. 2017 Jul 8.

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