ASCO: Updated Guidelines for Hepatitis B Screening
The American Society of Clinical Oncology (ASCO), recently updated their hepatitis B screening guidelines. The Provisional Clinical Opinion on hepatitis B is based on a rigorous, evidence-based approach and is periodically updated to reflect recently published data.
The American Society of Clinical Oncology updated their 2020 guidelines on hepatitis B and cancer screening. Most importantly, ASCO recommends universal screening for hepatitis B for patients undergoing cancer therapy. ASCO states that all cancer patients anticipating systemic anticancer therapy should be screened for hepatitis B through three tests. People living with chronic hepatitis B (HBV) receiving any systemic anticancer therapy should receive antiviral prophylaxis for the duration of anticancer therapy, as well as for at least 12 months after receipt of the last anticancer therapy. Antiviral therapy and management for cancer patients should follow national HBV guidelines, independent of cancer therapy, including management by a clinician experienced in HBV management for prevention of liver diseases such as cirrhosis or liver cancer. Patients with past HBV receiving anticancer therapies associated with an established high risk of HBV reactivation should be started on antiviral prophylaxis at the beginning of anticancer therapy and continued on antiviral therapy for at least 12 months after anticancer therapy ends. Patients with past HBV infection undergoing anticancer therapies that are not clearly associated with a high risk of HBV reactivation should be followed carefully during cancer treatment, with HBsAg and ALT testing every 3 months.
Risk Factors for HBV Reactivation
The article states a few risk factors for hepatitis B reactivation. These risk factors include types of cancers, various anticancer therapies, immunotherapy, radiation therapy and transarterial chemoembolization, other B-cell agents, and special situations. Because of these risk factors for hepatitis B reactivation, it is important for health care professionals to screen for hepatitis B prior to cancer treatment.
What Does This Mean for Providers
Oncologists and healthcare providers have a responsibility to screen their cancer patients for hepatitis B prior to treatment. Screening is especially important among vulnerable populations such as persons of Asian, Pacific Islander and African descent who are disproportionately affected by hepatitis B.
What Does This Mean for Patients
Patients with cancer should also advocate for themselves in healthcare settings to ask for a hepatitis B panel screening before treatment. Your provider will be able to interpret your test results, but here is a simple table to help you understand your hepatitis B panel screening results.
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Hwang, J. P., Feld, J. J., Hammond, S. P., Wang, S. H., Alston-Johnson, D. E., Cryer, D. R., Hershman, D. L., Loehrer, A. P., Sabichi, A. L., Symington, B. E., Terrault, N., Wong, M. L., Somerfield, M. R., & Artz, A. S. (2020). Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, JCO2001757. Advance online publication. https://doi.org/10.1200/JCO.20.01757
Evangeline Wang, Public Health Program and Outreach Coordinator at the Hepatitis B Foundation
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