Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: A 16-year population-based study

Authors

  • Brian J. McMahon,

    Corresponding author
    1. Departments of Internal Medicine and Surgery, Alaska Native Medical Center, Indian Health Service, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
    2. Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
    • Arctic Investigations Program, Centers for Disease Control and Prevention, 4055 Tudor Centre Drive, Anchorage, AK 99508. fax: 907-729-3429
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  • Lisa Bulkow,

    1. Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
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  • Annette Harpster,

    1. Departments of Internal Medicine and Surgery, Alaska Native Medical Center, Indian Health Service, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
    2. Alaska Native Health Board, Anchorage, Alaska
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  • Mary Snowball,

    1. Departments of Internal Medicine and Surgery, Alaska Native Medical Center, Indian Health Service, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
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  • Anne Lanier,

    1. Alaska Native Health Board, Anchorage, Alaska
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  • Frank Sacco,

    1. Departments of Internal Medicine and Surgery, Alaska Native Medical Center, Indian Health Service, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
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  • Eitel Dunaway,

    1. Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
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  • James Williams

    1. Departments of Internal Medicine and Surgery, Alaska Native Medical Center, Indian Health Service, Public Health Service, U.S. Department of Health and Human Services, Anchorage, Alaska
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Abstract

The benefits of screening hepatitis B surface antigen (HBsAg)-positive carriers for hepatocellular carcinoma (HCC) in terms of long-term survival have not been established. We conducted a prospective 16-year, population-based cohort study to determine the impact of screening for HCC in 1,487 HBsAg-positive Alaska native carriers with alpha-fetoprotein (AFP) determinations every 6 months. Men and nonpregnant women with an elevated AFP level were evaluated for the presence of HCC by ultrasound (US) examination. The long-term survival rate for patients whose HCC was detected by the screening program was compared with a historical control group of Alaska native patients with HCC from the same population who were clinically diagnosed with HCC between 1969 and October 1982, through a National Cancer Institute–sponsored Cancer Registry. Between October 1982 and December 1998, 26,752 AFP determinations in HBsAg carriers were performed. One or more AFP elevations were found in 61 men and 39 nonpregnant women. HCC was diagnosed in 32 patients (24 men and 8 women). HCC tumors less than 6 cm were found in 23 patients; 22 patients had resections, and 1 patient refused a resection. Compared with 12 patients with hepatitis B virus (HBV)-related HCC diagnosed from 1969 to October 1982, before this program, the 5- and 10-year survival rate for the 32 patients with HCC were 42% (P = .008) and 30% (P = .07), respectively. Five- and 10-year tumor-free survival rates for carriers who had a normal AFP level on initial screening and subsequently developed HCC were 29% (P = .004) and 24% (P = .024), respectively. Screening of HBsAg carriers with semiannual AFP was effective in detecting most HCC tumors at a resectable stage and significantly prolonged survival rates when compared with historical controls in this population.

Ancillary