Editorial : Killing Two Birds With One Stone: Screening for Chronic Hepatitis C at the Time of Colonoscopy in the Baby Boomer Cohort

Abstract

Colonoscopy is a well-accepted colon cancer screening modality that is recommended by the United States Multi-Society Task Force on all individuals greater than 50 years of age. Chronic hepatitis C (CHC) is a common cause of chronic liver disease with notably increased rates of infection in individuals born between 1945 and 1965. The Centers for Disease Control recently recommended all individuals of this " Baby Boomer " cohort undergo one time screening for CHC. As gastroenterologists interface with these patients for screening colonoscopy, this represents a unique opportunity to complete this screening and identify CHC patients at risk for advanced liver disease. Am J Gastroenterol 2013; 108:990 -992; doi: 10.1038/ajg.2013 Th e United States Multi-Society Task Force fi rst included screening colonoscopy in its 1997 guidelines, which recommended colonoscopy, fl exible sigmoidoscopy, or fecal occult blood cards beginning at age 50. Colonoscopy is viewed by many as unpleasant, embarrassing, or uncomfortable, but despite this, screening rates for patients over 50 have increased considerably since 1987, rising from about 30 % to >50 % in 2005 ( 1 ). Colonoscopy is the most preferred colon cancer screening modality according to a large survey of Canadian physicians with 56 % selecting optical colonoscopy followed by 27 % preferring fecal occult blood testing ( 2 ). With the evolution of computed tomographic colonography, optical colonoscopy still remains the most widely available colon cancer screening modality ( 3 ). In the US population, the best available data reported 38.7 -40.4 % of patients older than 50 had received a fl exible sigmoidoscopy or colonoscopy in a 5-year period ( 4,5 ). Other countries have reported lower rates of colon cancer screening: a recent prospective study in Germany evaluating the effi cacy of screening colonoscopy found the cumulative participation rate to be 17 % for women and ~ 15 % for men aged 55 -74 ( 6 ).Even with the substantially lower rates of colonoscopy reported in this more recent study, it still represents a large group totaling almost 3 million individuals in Germany alone who interface with the Gastroenterology medical community. Th is is undoubtedly a prime opportunity to address other common gastrointestinal (GI) focused diseases that aff ect this population. Liver disease is not oft en a focus of many private GI practices, but as it accounts for as much morbidity and mortality as luminal GI disease, it warrants some attention. A particular liver disease that has seen great advances in treatment in the last 2 years is chronic hepatitis C (CHC) infection. CHC is one of the most common indications for liver transplant and the overall prevalence in the general population is 1 -2 % with high rates of infection in prisoners, the homeless, and US veterans ( 7 ). Th e " Baby Boomer " cohort born between 1945 and 1965 is another high-risk subgroup of patients with data suggesting >5 % prevalence of CHC ( 8 ). Th e majority of these individuals were infected before th...

Test4HepC: Promoting Hepatitis C Testing to Baby Boomers Using Social Media

“…Despite these recommendations, an estimated 43% to 85% of people with HCV are unaware of their infection and therefore unable to benefit from treatment (Smith et al, 2012; Southern et al, 2011; Spradling et al, 2012). Multiple screening tactics have been employed to reach undiagnosed baby boomers, including hospital-based interventions, community-based programs, educational efforts, and adding HCV screening onto routine medical procedures (Thuluvath, Feldman, Horowitz, & Lowe, 2016; Torres & Harrison, 2013; Turner et al, 2015). However, additional innovative strategies are needed to identify the millions of adults with HCV so that they can avoid the potentially dire outcomes associated with untreated infection.…”

Disease burden of hepatitis C in the Austrian state of Tyrol – Epidemiological data and model analysis to achieve elimination by 2030

“…The United States Center for Disease Control and Prevention recommends one-time testing for persons born from 1945–1965[ 18 ]. For this high-risk birth cohort in Austria, and in particular in Tyrol, screening colonoscopy is a potential screening opportunity, which has been proven to be acceptable and effective[ 19 , 20 ]. According to the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), HCV testing should be performed annually in individuals on opiate substitution therapy and in persons with ongoing risk factors (persons who inject drugs and HIV-infected men who have unprotected sex with men)[ 21 , 22 ].…”