title: Evaluation of abdominal ultrasonography mass screening for hepatocellular carcinoma in Taiwan.
abstract: Mass screening with abdominal ultrasonography (AUS) has been suggested as a tool to control adult hepatocellular carcinoma (HCC) in individuals, but its efficacy in reducing HCC mortality has never been demonstrated. This study aimed to assess the effectiveness of reducing HCC mortality by mass AUS screening for HCC based on a program designed and implemented in the Changhua Community-based Integrated Screening (CHCIS) program with an efficient invitation scheme guided by the risk score. We invited 11,114 (27.0%) of 41,219 eligible Taiwanese subjects between 45 and 69 years of age who resided in an HCC high-incidence area to attend a risk score-guided mass AUS screening between 2008 and 2010. The efficacy of reducing HCC mortality was estimated. Of the 8,962 AUS screening attendees (with an 80.6% attendance rate), a total of 16 confirmed HCC cases were identified through community-based ultrasonography screening. Among the 16 screen-detected HCC cases, only two died from HCC, indicating a favorable survival. The cumulative mortality due to HCC (per 100,000) was considerably lower in the invited AUS group (17.26) compared with the uninvited AUS group (42.87) and the historical control group (47.51), yielding age- and gender-adjusted relative mortality rates of 0.69 (95% confidence interval [CI]: 0.56-0.84) and 0.63 (95% CI: 0.52-0.77), respectively.
  
  
  CONCLUSIONS
  The residents invited to community-based AUS screening for HCC, compared with those who were not invited, showed a reduction in HCC mortality by ∼ 31% among subjects aged 45-69 years who had not been included in the nationwide vaccination program against hepatitis B virus infection.
authors.affiliation: Changhua County Public Health Bureau, Changhua, Taiwan.
authors.forename: Yen-Po
authors.initials: YP
authors.lastname: Yeh
authors.forename: Tsung-Hui
authors.initials: TH
authors.lastname: Hu
authors.forename: Po-Yuan
authors.initials: PY
authors.lastname: Cho
authors.forename: Hsiu-Hsi
authors.initials: HH
authors.lastname: Chen
authors.forename: Amy Ming-Fang
authors.initials: AM
authors.lastname: Yen
authors.forename: Sam Li-Sheng
authors.initials: SL
authors.lastname: Chen
authors.forename: Sherry Yueh-Hsia
authors.initials: SY
authors.lastname: Chiu
authors.forename: Jean Ching-Yuan
authors.initials: JC
authors.lastname: Fann
authors.forename: Wei-Wen
authors.initials: WW
authors.lastname: Su
authors.forename: Yi-Jen
authors.initials: YJ
authors.lastname: Fang
authors.forename: Shih-Tien
authors.initials: ST
authors.lastname: Chen
authors.forename: Hsiao-Ching
authors.initials: HC
authors.lastname: San
authors.forename: Hung-Pin
authors.initials: HP
authors.lastname: Chen
authors.forename: Chao-Sheng
authors.initials: CS
authors.lastname: Liao
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000401:mortality; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D012306:Risk; D013624:Taiwan / Q000453:epidemiology; D014463:Ultrasonography