Screening leads to better survival

Hepatitis B virus (HBV) infection is endemic in Asia. Some infected individuals become chronic carriers when their body cannot clear the virus from the system. Apart from HBV, hepatitis C virus (HCV) infection is another global health problem. Both HBV and HCV carriers are at much increased risk of developing primary liver cancer or hepatocellular carcinoma (HCC). The frightening thing about HCC is that people who developed HCC are usually asymptomatic. When they become symptomatic, the cancer is usually at an advanced stage. As the only curative treatment for HCC is complete surgical removal or liver transplantation, early discovery is the key to long term survival. Hence, all HBV and HCV carriers are advised to undergo six-monthly screening with ultrasound scanning of the liver and blood test to detect an abnormal level of alpha-fetoprotein (AFP). Does six-monthly screening really lead to better survival for this group of patients?

Researchers from the Department of Surgery, University of Hong Kong published the findings of their study on 1366 patients, with HCC due to HBV or HCV infection, who were treated surgically from January 1991 to December 2004 (Ann Surg 2008 247: 666 – 673). These patients were referred for treatment either because the HCC was detected by screening or when the patient had become symptomatic. Long-term survival was significantly better in the screened group than in the symptomatic group of patients. The median survival was 61.9 months for the screened patients but was only 11.5 months for the symptomatic patients. The advent of new treatment methods, such as liver transplantation and radio-frequency ablation (RFA), also led to better survival for screened patients but made no impact on the symptomatic patients.

The above study has confirmed the findings of previous studies in that screening helps and leads to better patient outcome. Why? Screening leads to the detection of the underlying tumour at an earlier stage. This gives the doctors a chance to treat the HCC surgically, thus, leading to longer survival. Unfortunately we still see HBV patients who present only when symptomatic. When asked why they did not go for regular screening, the answers were either “Every time the doctor says everything is fine, so after a while I decided it was alright to skip the screening for a while.” or “I thought I would get some symptoms when the liver cancer started”.

If you are an HBV or an HCV carrier, please don’t skip your regular screening sessions. It is a bit like playing Russian roulette with your life. It’s not worth it!