ABSTRACT
High rates of hepatitis B virus infection and primary hepatocellular carcinoma are present among Alaskan Natives. To determine if primary hepatocellular carcinoma could be detected at an early surgically resectable stage, serological screening for elevated alpha-fetoprotein levels was done semiannually among Alaskan Natives infected with hepatitis B virus. During a 26-month screening period, 3,387 alpha-fetoprotein tests were performed on 1,394 persons. Of 126 persons with elevated levels of alpha-fetoprotein (greater than 25 ng/mL), nine males were found to have primary hepatocellular carcinoma (all with alpha-fetoprotein levels greater than 350 ng/mL). Six of these nine persons were asymptomatic for primary hepatocellular carcinoma and four had small tumors (less than 6 cm) that were surgically resected. After surgery, the alpha-fetoprotein levels in all four patients fell to normal and have remained normal after a follow-up of four to 20 months (median, ten months). alpha-Fetoprotein screening proved to be an effective approach in this population in detecting primary hepatocellular carcinoma at a potentially curable stage and should be considered in other individuals or populations infected with hepatitis B virus.
Subject(s)
Carcinoma, Hepatocellular/prevention & control , Hepatitis B/complications , Liver Neoplasms/prevention & control , alpha-Fetoproteins/analysis , Adolescent , Adult , Alaska , Carrier State/immunology , Child , Child, Preschool , Female , Hepatitis B/immunology , Hepatitis B Surface Antigens/analysis , Humans , Inuit , Male , Mass Screening , Middle Aged , Time FactorsABSTRACT
Serum levels of alpha-fetoprotein (AFP) may be raised for up to 2 years before clinical presentation of primary hepatocellular carcinoma (PHC). A group of people judged to be at high risk of PHC because of long-term serological positivity for hepatitis B surface antigen, ethnicity, location of residence, and a strong family history of PHC were screened for increasing levels of AFP. After 1 1/2 years of twice-yearly screening, one of them, a 19-year-old Eskimo man, had a raised AFP level, which continued to rise rapidly over the next 3 months, although the patient remained symptomless and ultrasonography, 99mTc-scan, and computerised tomography of the liver were negative. Hepatic angiography suggested a small tumour in the periphery of the right lobe of the liver, but at laparotomy the right lobe was normal. Instead a tumour was found in the lateral tip of the left lobe. The tumour, a PHC, was resected surgically, and the patient has been well in the 11 months since his operation. His serum AFP level returned to normal 2 weeks after the operation and has remained normal.