Evaluation of abdominal ultrasonography mass screening for hepatocellular carcinoma in Taiwan

Abstract

Mass screening with abdominal ultrasonography (AUS) has been suggested as a tool to control adult hepatocellular carcinoma (HCC) in individuals, but its efficacy in reducing HCC mortality has never been demonstrated. This study aimed to assess the effectiveness of reducing HCC mortality by mass AUS screening for HCC based on a program designed and implemented in the Changhua Community-based Integrated Screening (CHCIS) program with an efficient invitation scheme guided by the risk score. We invited 11,114 (27.0%) of 41,219 eligible Taiwanese subjects between 45 and 69 years of age who resided in an HCC high-incidence area to attend a risk score-guided mass AUS screening between 2008 and 2010. The efficacy of reducing HCC mortality was estimated. Of the 8,962 AUS screening attendees (with an 80.6% attendance rate), a total of 16 confirmed HCC cases were identified through community-based ultrasonography screening. Among the 16 screen-detected HCC cases, only two died from HCC, indicating a favorable survival. The cumulative mortality due to HCC (per 100,000) was considerably lower in the invited AUS group (17.26) compared with the uninvited AUS group (42.87) and the historical control group (47.51), yielding age- and gender-adjusted relative mortality rates of 0.69 (95% confidence interval [CI]: 0.56-0.84) and 0.63 (95% CI: 0.52-0.77), respectively. Conclusion: The residents invited to community-based AUS screening for HCC, compared with those who were not invited, showed a reduction in HCC mortality by ∼31% among subjects aged 45-69 years who had not been included in the nationwide vaccination program against hepatitis B virus infection. (Hepatology 2014;59:1840–1849)

Association between nucleos(t)ide analog and tumor recurrence in hepatitis B virus–related hepatocellular carcinoma after radiofrequency ablation

“…With a low survival rate of less than 12% in 5 years, HCC is the fastest rising cause of cancer death in the United States . Although HCC surveillance for high‐risk populations may contribute to early tumor treatment and reduced mortality rates, the clinical outcomes of patients receiving curative treatments remain unsatisfactory . Among HCC patients receiving potentially curative surgical resection, tumor recurrence rates can be as high as 50% in 3 years, and most tumor recurrences are clustered within 2 years of surgery .…”

Trends and predictors of outcomes after surgery for hepatocellular carcinoma: A nationwide population-based study in Taiwan

“…26 Although a nationwide vaccination program has been implemented in areas with a high prevalence of HBsAg and anti-HCV positivity, the risk for HCC remains high for people 40 years or older who have not been protected by HBV vaccination. 27 Therefore, a combination of a-fetoprotein and ultrasonography (US) has been used for surveillance in patients with chronic hepatitis infection in intervals of 3e6 and 6e12 months for cirrhosis and chronic liver disease, respectively. The screening protocol includes two stages.…”

Hepatocellular Carcinoma Risk in Alaska Native Children and Young Adults with Hepatitis B Virus: Retrospective Cohort Analysis

“…A majority of persons with HBV genotype F1 were diagnosed with HBV as children aged ≤18 years. Therefore, HCC surveillance should be considered for all persons with HBV genotype F1 infection regardless of age, especially since HCC surveillance could reduce HCC mortality (14, 15). …”