Community screening identifies undiagnosed chronic liver disease in high‐risk populations

Abstract

Background and Aim: Liver cirrhosis is the primary risk factor for the development of hepatocellular carcinoma. Most conditions that lead to cirrhosis are treatable, or modifiable. Therefore, a community-based screening program targeting high-risk groups was designed for early diagnosis and intervention of liver disease, to offset the rising burden of hepatocellular carcinoma in Australia. Methods: Two nurse consultants from a tertiary liver center performed community screening of pre-identified cohorts at risk of viral hepatitis and chronic liver disease, with transient elastography and/or serology testing for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV), in addition to standard blood tests. A positive screening result was defined as any of the following: liver stiffness measurement (LSM) ≥ 9.5 kPa, positive HCV RNA, or positive HBV surface antigen. Individuals who screened positive were linked to the liver center for management. Results: Nine hundred and twenty-six subjects were screened over a 6-year period, of which 122/926 (13.2%) had evidence of chronic liver disease. Chronic viral hepatitis was diagnosed in 91 participants (HBV = 23, HCV = 67, and co-infection = 1), while non-alcoholic fatty liver disease was diagnosed in 14 participants. Advanced fibrosis (LSM ≥ 9.5 kPa) was detected in 42/866 (4.9%) subjects with available LSM. Loss to follow-up occurred in 36/91 (39.6%) participants with chronic viral hepatitis. Conclusions: Targeting high-risk populations for community screening and intervention increases early identification of chronic liver disease. This may reduce the incidence of liver cirrhosis and hepatocellular carcinoma. Loss to follow-up remains an ongoing challenge, requiring better strategies.

The role of nursing in the management of patients with renal and hepatic cancers: A systematic literature review

“…The benefits of nurse involvement in HCC screening are reported in several studies (Aberra et al, 2013;Kennedy et al, 2013;Maher et al, 2021;Nazareth et al, 2016). A nurse-led community-based liver disease screening programme in high-risk individuals found evidence of liver disease in 13.2% (of 926 individuals screened), illustrating the value of such initiatives in supporting early identification of chronic liver diseases and HCC (Maher et al, 2021).…”

“…The benefits of nurse involvement in HCC screening are reported in several studies (Aberra et al, 2013;Kennedy et al, 2013;Maher et al, 2021;Nazareth et al, 2016). A nurse-led community-based liver disease screening programme in high-risk individuals found evidence of liver disease in 13.2% (of 926 individuals screened), illustrating the value of such initiatives in supporting early identification of chronic liver diseases and HCC (Maher et al, 2021). A nurse-led HCC surveillance clinic for patients with cirrhosis or advanced fibrosis in a hospital in Perth (n = 76), Australia, led to 30.3% of patients receiving follow-up ultrasounds within 6 months of their previous ultrasound, and 71.2% receiving them within 7 months.…”

A Discrete Choice Experiment to Elicit Preferences for a Liver Screening Programme in Queensland, Australia: A Mixed Methods Study to Select Attributes and Levels

“…Screening programmes can be effective in the early identi cation of advanced brosis, enabling intensive management while there is opportunity for reversal of steatosis/ brosis and early liver cancer surveillance, which increase the applicability and cost-effectiveness of hepatocellular carcinoma therapies. (25).…”