title: Adherence to screening for hepatocellular carcinoma among patients with cirrhosis or chronic hepatitis B in a community setting.
abstract: BACKGROUND
  Screening for hepatocellular carcinoma (HCC) has been shown to improve survival via earlier cancer detection. Although HCC screening is considered standard of care in the USA, little is known of the adherence to this practice, especially in a community setting.
  
  
  OBJECTIVE
  Our primary goal was to evaluate adherence to HCC screening and to find predictors of screening adherence in a community setting. Our secondary objective was to determine the impact of screening on survival.
  
  
  METHODS
  We studied a cohort of 557 consecutive patients at high risk for HCC: patients with cirrhosis and older chronic hepatitis B (CHB) patients without cirrhosis (≥45 years old). Patients initiated screening 1/2001-1/2005 and were monitored ≥12 months to 12/2008 in two community gastroenterology clinics in Northern California. HCC screening was categorized into four groups based on combined frequency of serum alpha-fetoprotein and imaging: optimal, suboptimal, poor, and no screening.
  
  
  RESULTS
  About 40.6% of our cohort received poor or no screening. Noncirrhotic CHB patients had worse screening than cirrhotic patients. Multivariate analysis revealed that patients with a greater number of clinical visits per year were 3.4 times more likely to have regular screening than patients with fewer clinical visits per year (P<0.001). There was a trend for association between HCC screening and greater access to curative treatment.
  
  
  CONCLUSIONS
  Since more frequent clinic visits is a strong independent predictor of improved screening adherence, regular routine clinic visits may help improve adherence to HCC screening, which may also lead to improved clinical outcomes.
authors.affiliation: Pacific Health Foundation, San Jose, CA, USA. carrie.r.wong@gmail.com
authors.forename: Carrie R
authors.initials: CR
authors.lastname: Wong
authors.forename: Ruel T
authors.initials: RT
authors.lastname: Garcia
authors.forename: Huy N
authors.initials: HN
authors.lastname: Trinh
authors.forename: Khoa D
authors.initials: KD
authors.lastname: Lam
authors.forename: Nghi B
authors.initials: NB
authors.lastname: Ha
authors.forename: Huy A
authors.initials: HA
authors.lastname: Nguyen
authors.forename: Khanh K
authors.initials: KK
authors.lastname: Nguyen
authors.forename: Brian S
authors.initials: BS
authors.lastname: Levitt
authors.forename: Mindie H
authors.initials: MH
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D002140:California; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy / Q000821:virology; D016009:Chi-Square Distribution; D003153:Community Health Services / Q000706:statistics & numerical data; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy / Q000821:virology*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000628:therapy / Q000821:virology; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009819:Office Visits; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins