By Christopher S. Cutler, M.D.
The American Cancer Society estimates that 40,000 Americans will be diagnosed with liver cancer this year, and 28,000 will die from this disease. But routine screening of the general population is not recommended. So who should be screened?
The following people should be screened for liver cancer:
All people with cirrhosis (severe scarring of the liver) from any cause should be screened.
The following people with chronic hepatitis B should be screened:
- Asian males > 40 years of age
- Asian females > 50 years of age
- People with a family history of liver cancer
- African Americans
- Caucasians with a high viral load and active inflammation for several years (start screening men > 40 years of age and women > 50 years of age)
How should patients be screened?
Screening should be done with an ultrasound every 6 months. Some experts also recommend checking a blood test called an alpha-fetoprotein (AFP) every 6 months. Adding an AFP to an ultrasound increases detection rates, but it also increases costs and false positive rates.
What should be done if a nodule is seen on ultrasound?
If the nodule is < 1 cm, an ultrasound should be done every 3 months until the nodule is proven to be stable or disappears (up to 24 months).
If the nodule is > 1 cm, a CT scan or MRI should be obtained, with a possible biopsy thereafter.