title: Hepatocellular Carcinoma Risk in Alaska Native Children and Young Adults with Hepatitis B Virus: Retrospective Cohort Analysis.
abstract: OBJECTIVE
  To evaluate the hepatocellular carcinoma (HCC) risk in Alaska Native children and young adults with hepatitis B virus (HBV).
  
  
  METHODS
  Retrospective analysis of a population-based cohort of Alaska Native persons with HBV followed during 1982-2012. All individuals with HBV were offered HCC screening regardless of age using alpha-fetoprotein every 6 months; persons with an elevated alpha-fetoprotein or persons at high-risk for HCC, such as cirrhosis, family history of HCC, were offered ultrasound. We calculated the HCC incidence/1000 person-years from date of cohort entry until death, diagnosis of HCC, or attaining the age of 40 years (males) or 50 years (females).
  
  
  RESULTS
  We followed 1083 subjects with HBV (56% male) comprising 5 genotypes (A2 [12.5%], B6 [1.7%], C [5.3%], D [49.7%], F1 [18.6%], unknown [12.4%]) for a median of 23.4 years/person. We observed 22 HCC cases (incidence/1000 person-years follow-up: 1.0); 19 HCC cases among persons with genotype F1. There was no significant difference in HCC incidence between males (1.4) and females (0.6). The HCC incidence was significantly higher for persons with genotype F1 (4.4) compared with genotype A2 (0.4) and D (0.2) and remained higher among persons with HBV genotype F1 excluding persons with HCC family history/cirrhosis (1.9).
  
  
  CONCLUSIONS
  Alaska Native children and young adults with HBV genotype F1 are at high risk for HCC and should receive HCC surveillance. For males <40 years of age and females <50 years of age with HBV in regions of the world with a high genotype F prevalence, testing/confirming genotype F can identify persons who could benefit from HCC surveillance.
authors: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention, Anchorage, AK.
authors: Prabhu P
authors: PP
authors: Gounder
authors: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors: Lisa R
authors: LR
authors: Bulkow
authors: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Mary
authors: M
authors: Snowball
authors: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors: Susan
authors: S
authors: Negus
authors: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Philip R
authors: PR
authors: Spradling
authors: Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium, Anchorage, AK.
authors: Brian J
authors: BJ
authors: McMahon
mesh_terms: D000328:Adult; D000072957:Alaska Natives / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000208:ethnology* / Q000821:virology; D002648:Child; D015331:Cohort Studies; D005260:Female; D005838:Genotype; D006509:Hepatitis B / Q000150:complications*; D006515:Hepatitis B virus / Q000235:genetics*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000208:ethnology* / Q000821:virology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D000509:alpha-Fetoproteins
chemical_list: D000509:alpha-Fetoproteins
keywords: cancer screening; cohort study; diagnosis; epidemiology; incidence study