Screening for hepatocellular cancer: Recommended, but should we do it?
M. Brian Fennerty • April 2nd, 2012
Most gastroenterologists are aware of the increasing incidence of hepatocellular cancer (HCC) in patients with cirrhosis. Most are also aware of the updated 2011 guidelines from the American Association for Study of Liver Diseases that recommend screening many patients with cirrhosis for HCC with every 6-month ultrasound examinations. These guidelines are based largely on a cost-effectiveness analysis showing that, at a certain threshold, incidence of HCC screening would be cost-effective in various cirrhotic states. However, there is a lack of data from prospective trials showing that screening is effective in preventing death from HCC and almost no data on the efficacy of such an intervention in the U.S.
1. Do you think we should screen patients with cirrhosis for HCC?
2. How effective do you think such screening is?
3. How would you screen (ultrasound, CT, MRI, alpha fetoprotein)?
4. What frequency intervals should be used?
5. If you do not screen, what data would compel you to begin screening?
I look forward to the discussion.