Abstract IA32: Liver cancer screening—How much progress have we really made?

Abstract

Abstract Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide and a leading cause of morbidity and mortality in patients with cirrhosis. Given an aging population of patients with hepatitis C virus (HCV) infection and a growing population of patients with nonalcoholic fatty liver disease (NAFLD), the incidence of HCC is anticipated to continue rising over the next 20 years. HCC disproportionally affects racial/ethnic minority populations in the United States, with higher age-specific rates among non-Hispanic Black, Hispanic white, and Asian persons compared to non-Hispanic whites. Studies have also suggested racial and ethnic disparities in HCC early detection, treatment receipt, and prognosis, with Black and Hispanic patients with HCC having worse overall survival than White and Asian patients. One of the strongest determinants of HCC-related prognosis is tumor burden at the time of diagnosis, with curative options only available for patients diagnosed at an early stage. Patients detected at an early stage can be treated with curative therapies such as liver transplantation or surgical resection, achieving 5-year survival rates exceeding 60%, whereas those detected at more advanced stages are only amenable to palliative therapies, with a median survival of 1-2 years. Therefore, several professional societies recommend HCC screening in at-risk patients (most notably patients with chronic hepatitis B infection or those with cirrhosis from any etiology) with an abdominal ultrasound and a blood test, alpha fetoprotein, every 6 months. HCC screening has been associated with improved early detection, increased curative treatment, and improved survival in several cohort studies. However, HCC screening is underused in clinical practice, with fewer than 20% of at-risk patients receiving consistent semiannual HCC screening. Studies suggest lower HCC screening receipt in racial/ethnic minorities and persons of low socioeconomic status, although no studies have been sufficiently large to evaluate intersectionality of race/ethnicity and socioeconomic status. Survey studies suggest several provider-level and patient-level barriers to HCC screening that likely must be addressed to increase HCC screening, particularly among socioeconomically disadvantaged patients and those being followed outside of tertiary care referral centers. Although few studies have evaluated interventions to increase HCC screening, some have yielded early promising results. Citation Format: Amit G. Singal. Liver cancer screening—How much progress have we really made? [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA32.