Community-based Hepatocellular Carcinoma Screening in Taiwan
Date Issued
2005
Date
2005
Author(s)
Jan, Chyi-Feng
DOI
en-US
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common neoplasm, and the third most common cause of cancer-related death in the world. In Taiwan, HCC is also one of the most common neoplasm and the first leading cause of cancer death in recent decades. The risk factors of HCC include mainly hepatitis B infection (HBV), hepatitis C infection (HCV), alcohol use, aflatoxin, diabetes (DM) and obesity, etc. In addition to risk factors avoidance, early detection is the major strategy of intervention to prevent from HCC.
Both HCC mortality and incidence are noted to increase in the past two decades from national health statistics in Taiwan and a rapid rise in mortality from HCC has been observed in subjects aged 20 years and over since 1991. If the cause of increasing mortality of HCC is due to poor survival from HCC mainly, then improvement of treatment should be encouraged. On the contrary, if the cause is due to increasing incidence of HCC, then early detection for HCC would be mandatory. Therefore, the aim of the first part (Chapter 3) of this thesis study is to delineate the cause of rising mortality of HCC. We collected a total of 41,150 deaths and 51,201 incident HCC cases (ICD 9 code 155.0) aged 20-79 years between 1985 and 1998. Trends in HCC mortality rates were decomposed into two parts, the annual case-fatality rates and HCC incidence rates by age. Poisson regression was used to distinguish a cohort effect from a time period effect on the incidence of HCC. The results disclosed increased incidence, particularly in individuals over 50, rather than poor survival, accounts for the rapid rise in mortality from HCC in Taiwan. Thus early detection for HCC is very important regarding HCC prevention.
As to the risk factors of HCC, in addition to hepatitis B and hepatitis C, obesity and DM have also been proven to be highly associated with HCC in the western society. Because the lifestyle change in Taiwan moves more like the West, the possible changing of risk factors for HCC and the interactions between chronic diseases and hepatitis B/C deserves to be elucidated from the viewpoint of early prevention. It is timely to explore the associations between chronic diseases, particularly the factors related to metabolic syndrome (MS), and risk factors of HCC, especially hepatitis B and hepatitis C in Taiwan. The second part (Chapter 4) of this thesis study aims to see the relationship between MS and hepatitis B surface antigen (HBsAg), hepatitis C antibody (anti-HCV) status simultaneously with the help from using a large population-based data from Keelung Community Integrated Screening program (KCIS). A population-based cross-sectional study design was adopted with a total of 53,528 subjects being enrolled from KCIS. Evidence of past hepatitis B/C infection, acquired during childhood or as a young adult, was identified during the two-stage liver cancer screening part of the process. Information on biochemical markers and anthropometric measures related to MS, such as fasting blood sugar, triglyceride (TG) and high-density lipoprotein (HDL-C), abdominal circumference (WC) and blood pressure (BP), were collected routinely whilst screening for hypertension, type 2 DM, and hyperlipidemia. Logistic regression was used to estimate odd ratios (OR) and related 95% confidence interval (CI) for the associations between MS and hepatitis B/C infection. The results showed that there is an inverse association between MS and HBV infection whereas the association was heterogeneous for HCV infection with a positive association with abnormal HDL-C but an inverse association with hypertriglyceridemia. It needs further studies to clarify the potential different pathogenesis mechanism of non-alcoholic fatty liver diseases from hepatitis B and hepatitis C.
With regards to the secondary prevention of HCC, there are still lots of debates about screening for HCC. The third part (Chapter 5) of this thesis study wishes to demonstrate the efficacy of HCC screening program in terms of different strategy of screening interval using community-based randomized clinical trial. 4,319 non-liver cirrhotic subjects aged 38–72 years from 6 townships in Taiwan with at least 1 positive result from 5 markers including HBsAg positive, anti-HCV positive, alpha-fetoprotein (AFP) ≧ 20 ng/mL, aspartate transaminase (GOT) ≧ 40 IU/L, and alanine transaminase (GPT) ≧ 45 IU/L were invited to participate this randomised trial from September 1, 1999 and follow up until December 31, 2004. Repeated abdominal sonography (US) screening was offered to these subjects through randomised to two different screening intervals strategies, 6 months and 12 months respectively. The primary end point was to assess the effect of intensive strategy on mortality reduction compared with regular strategy. The results disclosed there was no difference between 6 months and 12 months screening interval strategies for HCC screening among non-cirrhotic high risk groups in hepatitis B hyperendemic area. Besides, no matter 6 months or one year screening interval for HCC screening among those who at high risk of HCC, the best way for high risk groups to prevent from HCC is to follow up regularly.
Subjects
細胞癌
死亡率
發生率
代謝症候群
B型肝炎
C型肝炎
社區篩檢
隨機分派臨床試驗
hepatocellular carcinoma
mortality
incidence
metabolic syndrome
hepatitis B
hepatitis C
screening, surveillance
randomized controlled trial
SDGs
Type
thesis
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