Friday, July 23, 2010

Screening for Hepatits C?

This week, the New York Times reported (story) on the status of our nation's efforts to control hepatitis C infections, which look grim in some ways, as rates of infection, and associated liver transplants continue to rise.  Some experts are excited about a new screening test which can detect hepatitis C infection immediately without waiting for outside lab testing.  This isn't a screening test for liver cancer, given that, as we've noted before (previous post), the test hasn't been evaluated for its effect on mortality.

In fact, only a fraction of those infected with hepatitis C go on to develop cirrhosis or liver cancer, and there is no test to identify those at greater risk of these serious complications.  However, it is hoped that with the improved treatments for hepatitis C infection now available, and described in the NY Times article, a test to screen for infection will lead to treatment and clearance of the infection, and thus, lower rates of liver cancer and liver cancer mortality.  But neither of these outcomes has yet been evaluated. And this is the big open question, since it isn't clear the treatment regimens are actually making a difference on rates of either cirrhosis or liver cancer, since many of those treated would never have gone on to cirrhosis or other serious problems.

Clearly, those who have been following CNiC in particular and cancer prevention news in general for a while are seeing some parallels here with other screening debates (previous screening posts), most notably the debate surrounding the risk and benefits of PSA screening for prostate cancer. However, we know that plenty of people prefer an approach for themselves that involves more testing as it makes them feel more secure in their health. Do you think promoting hepatitis C screening is premature or a way to help us find those with the infection and get them treated? Would you consider getting screened? Is this a good use of cancer prevention resources or should other programs receive priority?

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