Screening for Hepatocellular Carcinoma Among Veterans With Hepatitis C on Disease Stage, Treatment Received, and Survival

Background & Aims: The incidence of hepatocellular carcinoma (HCC) is increasing. Despite recommendations for HCC screening from the American Association for the Study of Liver Disease, the National Cancer Institute does not recommend screening. The question of whether screening is of benefit is an important one. The purpose of this study was to examine the determinants of screening, as well as the impact of screening on disease stage, treatment received, and survival in a US veteran population. Methods: Patients with hepatitis C and HCC who receive care in the South Texas Veteran Health Care System were identified using the Veterans Affairs national hepatitis C registry. Screening status was determined by chart review. Potential determinants of screening were assessed. Screened and unscreened patients were compared on the basis of disease stage at diagnosis, treatment received, and survival. Results: Seventy-two patients were identified and included in the analysis, of whom only 16 (22%) were screened. Patients seen by a hepatologist before diagnosis were more likely to be screened. All screened patients were diagnosed with early stage disease, compared with 22% of unscreened patients (P < .001). Screened patients were 10 times more likely to have received potentially curative treatment (95% confidence interval, 2.91-31.35). Log-rank test of equality of survivor functions was statistically significant for differences between screened and unscreened groups (P = .0005). Conclusions: Our findings support the American Association for the Study of Liver Disease screening recommendations, and suggest that screening is underused.