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Studies of patients with cirrhosis uncover limitations in liver cancer screening
Date:12/1/2011

Two studies available in the December issue of Hepatology, a journal of the American Association for the Study of Liver Diseases, have uncovered limitations in screening for primary liver cancer, also known as hepatocellular carcinoma (HCC). The first study found that, if given the choice during a clinical trial, most patients with cirrhosis prefer surveillance over the possibility of non-screening, therefore making a randomized study of HCC screening not feasible. A second study determined that ultrasonographic screening at three monthly versus six monthly intervals did not improve the detection of small liver cancers.

Medical evidence reports HCC to be the sixth most common cancer and the third most common cause of cancer death worldwide, with 90% of all cases in western countries attributed to chronic liver diseases, typically at the cirrhosis stage. The National Cancer Institute estimates that more than 26,000 cases and close to 20,000 deaths from liver and bile duct cancer occurred in the U.S. in 2011. Clinical guidelines recommend routine screening for HCC, but the efficacy and optimal intervals for testing are strongly debated by experts.

In the first study, researchers led by Professor Jacob George from the University of Sydney and Westmead Hospital in Australia, examined the feasibility of undertaking a randomized controlled trial of HCC surveillance in patients with cirrhosis. The screening program included ultrasonography every six months and alpha-fetoprotein testing every three months. Of the 205 participants with cirrhosis who received information outlining the risks and benefits of surveillance for liver cancer, 99.5% declined randomization, with 88% electing for a non-randomized screening program.

"While a randomized controlled trial is ideal to assess the success of a cancer surveillance program, we found that patients with cirrhosis declined randomization due to possible allocation to a non-screening group,
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Contact: Dawn Peters
healthnews@wiley.com
781-388-8408
Wiley-Blackwell
Source:Eurekalert

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