In the last 20 years in the United States, the incidence of hepatocellular carcinoma (HCC) has tripled from about 2 to 7 per 100,000 adults. In addition to the rising incidence, the cancer is also one of the most deadly, with a 5-year survival rate of only 18%.
These comments were made here by Anne Covey, MD, a radiologist from the Memorial Sloan Kettering Cancer Center, New York City, at the National Comprehensive Cancer Network (NCCN) 23rd Annual Conference in March.
Covey said physicians should be on the lookout for patients with diseases that precede a HCC diagnosis and should suggest screening if appropriate.
Two groups of patients should be screened for HCC: those with cirrhosis and all hepatitis B carriers, according to the NCCN guidelines.
Covey explained that cirrhosis is a pathologic diagnosis and is caused by other conditions. Most common causes are hepatitis B or C, alcohol abuse, genetic hemochromatosis, nonalcoholic liver diseases, advanced primary biliary cholangitis, and α1-antitrypsin deficiency.
Anyone with these diseases or conditions is at risk for HCC — but only if their disease first proceeds to cirrhosis.
Hepatitis B is the exception. An estimated 30% to 50% of patients with HCC and hepatitis B do not have cirrhosis. Hence, the recommendation is that all patients with hepatitis B be screened, including those who do not have cirrhosis.