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Hepatocellular Carcinoma Screening Rates Vary by Etiology of Cirrhosis and Involvement of Gastrointestinal Sub-specialists

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Abstract

Background

Regular screening of cirrhotic patients for hepatocellular carcinoma (HCC) has been suboptimal, but there is little data regarding specific risk factors for reduced screening.

Methods

From 1996 to 2010, patients with cirrhosis were retrospectively identified from outpatient gastroenterology and primary care practices. Data was obtained from the diagnosis of cirrhosis until the time of elevated alpha-fetoprotein (AFP) or lesion suspicious for HCC, death, liver transplantation, or end of the data collection period. Recommended screening was defined as abdominal imaging (ultrasound, contrast-enhanced CT, or MRI) with or without serum alpha-fetoprotein (AFP) at least once every 12 months based on professional guidelines.

Results

One hundred fifty-six patients with cirrhosis were identified. The etiologies of cirrhosis were viral hepatitis (n = 65), alcohol (n = 40), non-alcoholic steatohepatitis (NASH) (n = 27), and non-viral, non-alcoholic, non-NASH cirrhosis (n = 24). Of the 156 patients, 51% received recommended screening for HCC. Patients with NASH cirrhosis received recommended screening significantly less (p = 0.016) than cirrhotics with viral hepatitis, alcoholic cirrhosis, or non-viral, non-alcoholic, non-NASH cirrhosis and were less likely to receive gastroenterology referral (p < 0.001). Additionally, 20 patients were diagnosed with cirrhosis incidentally during a surgical procedure. These patients were significantly less likely to receive recommended HCC screening than those diagnosed non-surgically (10.0 vs. 56.6%; p < 0.001). Screening was significantly more likely to occur in patients seen regularly by a gastrointestinal subspecialist (66.7 vs. 22.8%; p < 0.001).

Conclusions

Patients with NASH cirrhosis and incidentally discovered cirrhosis have low rates of HCC screening and are referred less often to gastroenterologists. These data suggest a need for increased education about NASH cirrhosis and better systems of communication among general practitioners, surgeons, and gastroenterologists.

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Abbreviations

HCC:

Hepatocellular carcinoma

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

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Acknowledgments

We thank Dr. Kathleen Finn and Dr. Daniel Hunt for their critical reading of this manuscript and their suggestions. Part of this work was presented at a poster session at the 61st Annual Meeting of the American Association for the Study of Liver Diseases; 2010 November 2; Boston, MA. Raymond T. Chung was supported by NIH DK078772.

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Authors and Affiliations

  1. Department of Medicine, Massachusetts General Hospital, Warren 1007, 55 Fruit Street, Boston, MA, 02114, USA

    Vilas Patwardhan, Sonali Paul, Kathleen E. Corey, Sameer M. Mazhar, James M. Richter, Michael Thiim & Raymond T. Chung

  2. Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA

    Kathleen E. Corey, Sameer M. Mazhar, James M. Richter, Michael Thiim & Raymond T. Chung

Authors
  1. Vilas Patwardhan
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  2. Sonali Paul
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  3. Kathleen E. Corey
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  4. Sameer M. Mazhar
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  5. James M. Richter
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  6. Michael Thiim
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  7. Raymond T. Chung
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Corresponding author

Correspondence to Raymond T. Chung.

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Patwardhan, V., Paul, S., Corey, K.E. et al. Hepatocellular Carcinoma Screening Rates Vary by Etiology of Cirrhosis and Involvement of Gastrointestinal Sub-specialists. Dig Dis Sci 56, 3316–3322 (2011). https://doi.org/10.1007/s10620-011-1836-2

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  • DOI: https://doi.org/10.1007/s10620-011-1836-2

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