Screening for hepatocellular carcinoma in chronic carriers of hepatitis B virus: incidence and prevalence of hepatocellular carcinoma in a North American urban population.
OBJECTIVE
To prospectively determine the prevalence and annual incidence of hepatocellular carcinoma in hepatitis B carriers in a heterogeneous urban North American population and to assess the diagnostic accuracy of tests used for screening for this cancer.


METHODS
Prospective cohort study of 1,069 chronic carriers of hepatitis B virus using screening with alpha-fetoprotein alone or in combination with ultrasonography every 6 months.


RESULTS
The mean age of the cohort was 39 +/- 12 years (+/- SD), 65% were men, 71% were Asians. At the first screening visit, serum alpha-fetoprotein was > or = 20 micrograms/L in 4%. In those subjects who were also screened by ultrasonography during the first visit, 9% were found to have focal lesions. Only 3 subjects were found to have hepatocellular carcinoma at the first screening, giving a prevalence of 281/100,000 chronic carriers of hepatitis B virus. The cohort was followed for 2,340 person-years (mean, 26 months follow-up, with a range from 6 to 60 months). During this period, 11 more subjects, 10 men and 1 woman, were diagnosed to have hepatocellular carcinoma (annual incidence, 470/100,000). In men only, the annual incidence was 657/100,000. During the study, 5 subjects died from hepatocellular carcinoma (annual mortality rate, 214/100,000). Sensitivity and specificity of serum alpha-fetoprotein > 20 micrograms/L were 64.3% and 91.4%, respectively. For ultrasonography, sensitivity was 78.8% and specificity 93.8%.


CONCLUSIONS
These data suggest that the incidence and prevalence of hepatocellular carcinoma in hepatitis B carriers in our area, an urban North American setting, are as high as in countries where hepatitis B is endemic. Current screening tests have significant false-positive and false-negative rates raising questions about the cost-benefit of screening for hepatocellular carcinoma in our study population.
Sherman
M
M
Department of Medicine, Toronto Hospital, Ontario, Canada.
Peltekian
K M
KM
Lee
C
C
D000328:Adult; D000368:Aged; D001208:Asia / Q000208:ethnology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000821:virology*; D002353:Carrier State; D005060:Europe / Q000208:ethnology; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000000981:diagnostic imaging; D006510:Hepatitis B Antibodies / Q000097:blood; D006513:Hepatitis B e Antigens / Q000097:blood; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000208:ethnology; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
D006510:Hepatitis B Antibodies; D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins