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).
What happens when you drink alcohol?
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.
Liver cells contain enzymes (chemicals) which process (metabolise) alcohol. The enzymes break down alcohol into other chemicals which in turn are then broken down into water and carbon dioxide. These are then passed out in the urine and from the lungs. The liver cells can process only a certain amount of alcohol per hour. So, if you drink alcohol faster than your liver can deal with it, the level of alcohol in your bloodstream rises.
What are the problems of drinking too much alcohol?
Your liver and body can usually cope with drinking a small amount of alcohol. Indeed, drinking a small amount of alcohol (1-2 units per day) may help to prevent heart disease and stroke.
However, drinking over the recommended limits (detailed below) can be harmful. If you drink heavily you have an increased risk of developing:
- Serious liver problems (alcoholic liver disease).
- Some stomach disorders.
- Pancreatitis (severe inflammation of the pancreas).
- Mental health problems, including depression and anxiety.
- Sexual difficulties such as impotence.
- Muscle and heart muscle disease.
- High blood pressure.
- Damage to nervous tissue.
- Accidents - drinking alcohol is associated with a much increased risk of accidents. In particular, injury and death from fire and car crashes. About 1 in 7 road deaths are caused by drinking alcohol.
- Some cancers (mouth, gullet, liver, colon and breast).
- Obesity (alcohol has many calories).
- Damage to an unborn baby in pregnant women.
- Alcohol dependence (addiction).
In the UK, deaths due to alcohol-related diseases (particularly liver disease) have risen considerably over the last 20 years or so. This is because heavy drinking and binge drinking have become more common.
The rest of this leaflet is about alcoholic liver disease. See separate leaflets called Alcohol and sensible drinking, which deals with general aspects of alcohol, and Alcoholism and problem drinking, which includes information on alcohol dependence.
So the benefits of liver screening would need to outweigh the risks in order to recommend routinely screening people with alcoholic cirrhosis.
The current findings suggest they do not, Jepsen’s team reports in the Annals of Internal Medicine.
SPECIALIST GROUPS ALONE
The U.S. Preventive Services Task Force, a government-backed independent expert panel, has no recommendation on liver cancer screening.
Right now, screening is recommended by two specialist groups - the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver.
Both groups suggest that cirrhosis patients be screened every six months, Jepsen noted.
“But whether clinicians are actually offering this to their patients, and whether patients are compliant with (screening) - if given the offer - are unknown,” Jepsen said.
The American liver diseases group could not be reached for comment.