Screening for hepatocellular carcinoma in Alaska natives infected with chronic hepatitis B: A 16-year population-based study

The benefits of screening hepatitis B surface antigen (HBsAg)-positive carr iers for hepatocellular carcinoma (HCC) in terms of long-term survival have not been established. We conducted a prospective 16-year, population-based cohort study to determine the impact of screening for HCC in 1,487 HBsAg p ositive Alaska native carriers with alpha-fetoprotein (AFP) determinations every 6 months. Men and nonpregnant women with an elevated AFP level were e valuated for the presence of HCC by ultrasound (US) examination. The long-t erm survival rate for patients whose HCC was detected by the screening prog ram was compared with a historical control group of Alaska native patients with HCC from the same population who were clinically diagnosed with HCC be tween 1969 and October 1982, through a National Cancer institute-sponsored Cancer Registry. Between October 1982 and December 1998, 26,752 AFP determi nations in HBsAg carriers were performed. One or more AFP elevations were f ound in 61 men and 39 nonpregnant women. HCC was diagnosed in 32 patients ( 24 men and 8 women). HCC tumors less than 6 cm were found in 23 patients; 2 2 patients had resections, and 1 patient refused a resection, Compared with 12 patients with hepatitis B virus (HBV)-related HCC diagnosed from 1969 t o October 1982, before this program, the 5- and 10-year survival rate for t he 32 patients with HCC were 42% (P = .008) and 30% (P = .07). respectively . Five- and 10-year tumor-free survival rates for carriers who had a normal AFP level on initial screening and subsequently developed HCC were 29% (P = .004) and 24% (P = .024), respectively. Screening of HBsAg carriers with semiannual AFP was effective in detecting mast HCC tumors at a resectable s tage and significantly prolonged survival rates when compared with historic al controls in this population.