Adherence to Screening for Hepatocellular Carcinoma Among Patients with Cirrhosis or Chronic Hepatitis B in a Community Setting

  • Carrie R. Wong
  • Ruel T. Garcia
  • Huy N. Trinh
  • Khoa D. Lam
  • Nghi B. Ha
  • Huy A. Nguyen
  • Khanh K. Nguyen
  • Brian S. Levitt
  • Mindie H. Nguyen
Original Article

Abstract

Background

Screening for hepatocellular carcinoma (HCC) has been shown to improve survival via earlier cancer detection. Although HCC screening is considered standard of care in the USA, little is known of the adherence to this practice, especially in a community setting.

Aims

Our primary goal was to evaluate adherence to HCC screening and to find predictors of screening adherence in a community setting. Our secondary objective was to determine the impact of screening on survival.

Methods

We studied a cohort of 557 consecutive patients at high risk for HCC: patients with cirrhosis and older chronic hepatitis B (CHB) patients without cirrhosis (≥45 years old). Patients initiated screening 1/2001–1/2005 and were monitored ≥12 months to 12/2008 in two community gastroenterology clinics in Northern California. HCC screening was categorized into four groups based on combined frequency of serum alpha-fetoprotein and imaging: optimal, suboptimal, poor, and no screening.

Results

About 40.6% of our cohort received poor or no screening. Noncirrhotic CHB patients had worse screening than cirrhotic patients. Multivariate analysis revealed that patients with a greater number of clinical visits per year were 3.4 times more likely to have regular screening than patients with fewer clinical visits per year (P < 0.001). There was a trend for association between HCC screening and greater access to curative treatment.

Conclusion

Since more frequent clinic visits is a strong independent predictor of improved screening adherence, regular routine clinic visits may help improve adherence to HCC screening, which may also lead to improved clinical outcomes.

Keywords

Liver cancer Screening Chronic hepatitis B Cirrhosis HBV 

Abbreviations

HCC

Hepatocellular carcinoma

CHB

Chronic hepatitis B

HBV

Hepatitis B virus

HCV

Hepatitis C virus

AFP

Alpha-fetoprotein

US

Ultrasound

AASLD

American Association for the Study of Liver Diseases

HMO

Health maintenance organization

PPO

Preferred provider organization

WBC

White blood count

HCT

Hematocrit

PLT

Platelet count

INR

International normalized ratio

CR

Creatinine

TB

Total bilirubin

AST

Aspartate aminotransferase

ALT

Alanine aminotransferase

ALK

Alkaline phosphatase

CT

Computed tomography

MRI

Magnetic resonance imaging

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Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Carrie R. Wong
    • 1
  • Ruel T. Garcia
    • 1
    • 2
  • Huy N. Trinh
    • 1
    • 2
  • Khoa D. Lam
    • 1
    • 3
  • Nghi B. Ha
    • 1
  • Huy A. Nguyen
    • 2
  • Khanh K. Nguyen
    • 2
  • Brian S. Levitt
    • 2
  • Mindie H. Nguyen
    • 4
  1. 1.Pacific Health FoundationSan JoseUSA
  2. 2.San Jose GastroenterologySan JoseUSA
  3. 3.University of California at San Francisco School of MedicineSan FranciscoUSA
  4. 4.Division of Gastroenterology and HepatologyStanford University Medical CenterPalo AltoUSA

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