Study doubts value of liver cancer screening

Screening people with alcoholic liver damage for signs of cancer may not be worth the expense or other downsides, a new report says.

Alcoholism can lead to cirrhosis, or scarring, of the liver. People with cirrhosis have a higher-than-average risk of developing liver cancer, but it is not clear whether screening people with cirrhosis for the cancer extends lives.

In the new study, Danish researchers found that for alcoholic cirrhosis patients in their country, the risk of liver cancer is so low that screening may not be justified.

Of nearly 8,500 Danish adults hospitalized for alcoholic cirrhosis, the chance of developing liver cancer in the next five years was 1 percent, the study found.

That's well below the risk that justifies cancer screening, based on U.S. guidelines for cost-effectiveness.

In the U.S., an abdominal ultrasound would typically cost a few hundred dollars. Follow-up tests, if needed, could cost much more. But there are more than costs to consider when it comes to widespread cancer screening, said the lead researcher on the new study, Dr. Peter Jepsen of Aarhus University Hospital.

Alcoholic liver disease is often first suspected when tests for other medical conditions show that the liver has been damaged. Blood tests

Blood tests used to assess the liver are known as liver function tests. They can detect enzymes in your blood that are normally only present if your liver has been damaged.
Blood tests can also detect if you have low levels of certain substances, such as a protein called serum albumin, which is made by the liver. Low levels of serum albumin suggest that your liver is not functioning properly.

Further testing

If tests or your symptoms suggest that there is damage to your liver, your GP will ask you about your alcohol consumption. It is important to be totally honest about how much and how often you drink alcohol.

If you say you drink less alcohol than you do or deny drinking any alcohol, you may be referred for further unnecessary testing. This could lead to a delay in the treatment you need.

If your symptoms or liver function test suggest that you may have alcoholic hepatitis or cirrhosis, you may need further tests to assess the state of your liver.

Screening always carries some risk of falsely suggesting a person has cancer. And that leads to unnecessary further testing, which may be invasive.

Ultrasound is the method of choice for liver cancer screening, Jepsen told Reuters Health in an email. If that test suggests there is a tumor, the next step is usually a CT scan, which exposes the patient to radiation (at a much higher dose than with standard x-rays).

When you drink alcohol, it is absorbed into the bloodstream from the stomach and intestines. All blood from the stomach and intestines first goes through the liver before circulating around the whole body. So, the highest concentration of alcohol is in the blood flowing through the liver.