Sudden Controversy on Liver Cancer Screening…

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It has been suggested that people who suffer from alcoholic cirrhosis of the liver are at a higher risk of liver cancer. So, it would seem that liver cancer screening in this population would be advantageous in an effort to diagnosis and treat patients with liver cancer at an earlier stage.

However, the role of liver cancer screening is this population has not been previously established.  A study from Denmark, published in the Annals of Internal Medicine, finds that the value of liver cancer screening in patients that have alcoholic cirrhosis is not only unlikely to reduce the risk of death from cancer, it is also unlikely to be cost-effective.

Alcohol and Cirrhosis of the Liver

Years of heavy drinking can lead to inflammation of the liver and can eventually lead to scarring and cirrhosis of the liver. The scarring and cirrhosis replaces healthy tissue in the liver and the liver is unable to work properly. The damage caused by cirrhosis is irreversible and is permanent and will ultimately lead to liver failure.

While cirrhosis of the liver doesn’t occur in all heavy drinkers, the risk increases the longer a person drinks and with increased consumption of alcohol.  Symptoms of alcoholic liver disease (including cirrhosis) according to the U.S. National Library of Medicine, include: abdominal pain and swelling, decreased appetite and weight loss, nausea and vomiting, fatigue, dry mouth, increased thirst, yellowish skin and eyes, red veins of the skin, very dark or very pale skin, redness of the hands and feet, itching, difficulty thinking and remembering, mood changes, fainting, light headedness, and numbness in the hands and feet.

Danish Study of Liver Cancer Screening in Alcoholic Cirrhosis Patients

Dr. Peter Jepsen and his colleagues examined a nationwide Danish registry of 8, 482 patients that were admitted to the hospital with a first time diagnosis of alcoholic liver cirrhosis between 1993 and 2005.  They found that 169 of these patients developed liver cancer and 5,734 died.  Of the individuals that died, 151 had liver cancer.  The found that the incidence of liver cancer and the death rate from liver cancer was not greater in those that had alcoholic liver cirrhosis compared to those in the general population.  They concluded that individuals with alcoholic liver cirrhosis have a low risk of liver cancer and that death from liver cancer has little impact on this particular population.  The researchers go on to suggest that liver cancer screening in this population would have a minimal effect on death rates and would likely not be cost-effective.

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The researchers note that there are limitations to their study including that the diagnoses were made by hospital physicians and they did not use a set criteria.  Additionally, the data used was from a registry and therefore all care that patients may have received, including possible liver cancer screening, was not accessible.   They suggest that further, randomized controlled studies may find differing results, but that they based their conclusions on the data that was available.

Implications for the Future of Liver Cancer

The findings from this research suggests that putting patients that have alcoholic liver cirrhosis through various liver cancer screening tests including blood work, ultrasounds and possibly more advanced imaging techniques may not be the most beneficial or cost-effective strategy.  It would be more beneficial and cost effective to treat this population by offering them tools to help them abstain from alcohol, helping them to improve their nutrition and offering them counselling if necessary.

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