By Medimaging International staff writers
Posted on 20 May 2014
Image: Dr. Amit Singal, assistant professor of internal medicine and clinical sciences at the University of Texas Southwestern Medical Center – author of the paper “Early Detection, Curative Treatment, and Survival Rates for Hepatocellular Carcinoma Surveillance in Patients with Cirrhosis: A Meta-analysis” published in the Public Library of Science Medical Journal (Photo courtesy of the University of Texas Southwestern Medical Center).
Liver cancer survival rates could be improved if more individuals with cirrhosis are screened for tumors using inexpensive ultrasound scanning and blood tests, according to a recent review.
The meta-analysis of 47 studies involving more than 15,000 patients discovered that the three-year survival rate was much higher among patients who received liver cancer screening—51% for patients who were screened compared to 28% of unscreened patients. The review also found that cirrhosis patients who were screened for liver cancer were more likely to receive curative treatment instead of palliative care.
“Curative therapies, such as surgery or a liver transplant, are only available if patients are found to have liver cancer at an early stage. Unfortunately, right now, only a minority of patients’ cancers are found at an early stage,” said Dr. Amit Singal, an assistant professor of internal medicine and clinical sciences at the University of Texas (UT) Southwestern Medical Center (Dallas, USA), and medical director of the Liver Tumor Clinic in the Harold C. Simmons Cancer Center.
Dr. Singal’s findings, published April 1, 2014, in the Public Library of Science Medical Journal, are especially significant for Texas because the state has high rates of fatty liver disease and hepatitis C, both of which are correlated with cirrhosis. Texas also has the second highest incidence of hepatocellular carcinoma (HCC), the most typical type of liver cancer in the United States. Many cases of HCC can be caught early with screening. “We have a simple test, an abdominal ultrasound which is painless and easy, but we found that less than 20% of at-risk people have the test done, largely due to providers failing to order it,” Dr. Singal said.
Dr. Singal reported that he hopes his study will encourage both patients and doctors to request ultrasound screening. He noted that liver cancer screening is not yet recommended by the US Preventative Services Task Force, partly because a randomized study has not yet been done, which points to a conundrum in the field. When a randomized study was attempted in 2005, many patients chose to leave the study when they heard evidence that liver cancer screening could be so beneficial. None of the patients wanted to be the ones randomly chosen to not get the tests.
Dr. Singal hopes his findings will convince more cirrhosis patients and their doctors that screening is worthwhile. “Just because we don’t have a randomized trial doesn’t mean there isn’t a benefit. We’re stuck in the middle ground where we’ve gone halfway. People are starting to believe liver cancer screening is helpful, but there’s not enough evidence to prove a definite benefit,” Dr. Singal said. “Part of our goal is providing evidence to both patients and physicians that liver cancer screening is beneficial.”
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