Screening programs for liver diseases can detect asymptomatic conditions which might have better outcomes if diagnosed and treated earlier. However, such programs can also have undesirable consequences: they can be very costly; they might detect conditions which would never become a problem, they can lead to an array of unnecessary further testing and treatment; and lastly, diagnosis of certain conditions could lead to stigmatization of patients by insurance companies or society at large.

A panel of researchers considered the value and the drawbacks of screening for various liver diseases for an American Association for the Study of Liver Diseases (AASLD) workshop presented at Digestive Diseases Week 2003. Their evaluation is published in the May 2004 issue of Hepatology, the official journal of the AASLD. Published by John Wiley & Sons, Inc., Hepatology is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/hepatology.

Dawn Provenzale of Duke University Medical Center considered the cost-effectiveness of screening programs and found it was rare that screening programs saved money. "A seemingly inexpensive test, if suggested for a large number of subjects, can rapidly become an expensive program," she wrote. "A more expensive test with better operating characteristics (fewer false negatives and false positives) may actually be a better investment."

Mark Hall, of Wake Forest University Medical School, considered the potential for insurance discrimination against patients who are found to have a high genetic risk for certain liver diseases. Some fear that life and health insurers will use the results of genetic blood tests to refuse coverage. So far, there is no data that shows health insurers ask about or consider genetic test results. Still, more than half of all states have passed legislation forbidding health insurers from using predictive
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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
13-May-2004

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