Impact of age on screening and surveillance for primary liver cancer.
OBJECTIVE
Although screening and surveillance for liver cancers have become established practices, the impact of age on these practices is unknown. The age at which these could be stopped, if any, is unclear. Our aims were to assess the impact of age on developing or dying from liver cancer, and to define the relative impact of prematurely stopping screening.


METHODS
Actuarial life-table analyses were performed using age-stratified mortality rates for primary liver cancers, and for all other causes combined, obtained from population-based databases from the United States. The impact of prematurely stopping screening at a given age was expressed as days of life lost compared to the maximal benefit expected from lifelong screening.


RESULTS
Mortality from primary liver cancers increases with age and peaks at 37 per 100,000 persons at ages 85-90 yr. However, mortality from other causes increases even more with age. Consequently, the relative proportion of deaths from primary liver cancer is maximal at 1.34% of all deaths at age 50 yr, and gradually decreases thereafter. Eighty percent of the maximal potential benefit of lifetime screening from age 45 yr is achieved by age 77 yr, and 90% by age 82 yr.


CONCLUSIONS
The relative benefits from screening for primary liver cancer are reduced in the elderly due to competing risks for death despite an increasing incidence of primary liver cancer with age. The majority of societal benefit is gained from screening at younger ages, when the relative proportions of death attributable to liver cancer are the greatest.
Division of Gastroenterology, Scott and White Clinic, Texas A&M University System Health Science Center, College of Medicine, Temple, Texas 76508, USA.
Tushar
T
Patel
Cheryle
C
Dangell
Shail
S
Maheshwari
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D006801:Humans; D008017:Life Expectancy; D015993:Life Tables; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality; D008875:Middle Aged; D015233:Models, Statistical; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology