Who Should Be Screened?
Since liver cancer usually develops without symptoms, patients with chronic hepatitis B or C infections should be screened for liver cancer as part of their routine medical care. Some groups of patients, however, have a higher risk for liver cancer, so screening may be started earlier and done more frequently in these groups (see high risk groups listed below).
For persons with chronic hepatitis B infections, liver cancer can develop with or without cirrhosis, so regular cancer screening is essential.
The American Association for the Study of Liver Diseases (AASLD) recommends that in men infected with hepatitis B, liver cancer screening should start at age 40 years and in infected women at age 50 years.
Patients on a liver transplant waiting list also should be screened for liver cancer because they will be given higher priority if they have cancer. Also, cancer screening will help detect tumors before they are too large and result in the patient no longer meeting the requirements for a transplant.
High Risk Groups for Liver Cancer
Family History of Liver Cancer and Individuals with Cirrhosis
- Any patient who has a family history of liver cancer and/or has been diagnosed with cirrhosis, regardless of age, should be regularly screened for liver cancer.
Asian and Pacific Islanders
- Individuals of Asian and Pacific Islander descent have the highest incidence rate for chronic hepatitis B infections and liver cancer. In China, liver cancer is the leading cause of cancer death among men. In the United States, it is the 3rd leading cause of cancer deaths among Asian Americans (compared to the 8th leading cause of cancer deaths among Caucasian Americans).
- Recent studies suggest that younger Asian patients with chronic hepatitis B infection should be considered for early cancer screening programs regardless of their age, because they appear to have an increased risk for liver cancer, especially if they smoke or have a family history of liver cancer.
- Men born in Africa who are chronically infected with hepatitis B seem to progress to liver cancer at a younger age, so the AASLD recommends starting routine screening among these high-risk patients at age 20 years.
Co-Infections with HIV and/or Hepatitis C
- Liver disease may progress more rapidly in people who are co-infected with HIV and/or hepatitis B or C, and they are also at greater risk for developing liver cancer, so regular screening is essential.