Researchers also considered the potential value of screening for a number of specific liver conditions. While screening for hepatocellular carcinoma (HCC) might seem desirable, because the disease is more treatable when caught early, studies have shown that screening costs are very high per year of life saved. Still, hepatologists typically screen high-risk patients, despite a lack of proven value, and will probably continue to do so.

Hemochromatosis has been shown to have a strong genetic component, with men of Northern European ancestry at highest risk, therefore, screening of this population might be considered, the authors advised. For medication-related hepatotoxicity, they said the future of screening lies in pharmacogenomics.

Screening for chronic viral hepatitis (B and C) has been shown to have a positive impact on high-risk populations. It is warranted, the authors say, based on its effectiveness in reducing transmission as well as leading to treatment. However, they note that diagnosis of hepatitis B or C can lead to stigmatization or discrimination. The authors found that screening methods for two other liver conditions -- cirrhosis and portal hypertension -- have not been found to be sufficiently accurate.

In summary, the value of screening varies by condition, and therefore, should be carefully considered before being widely implemented. While it may be able to identify treatable or contagious liver conditions in some patients, it can also harm others by discovering disease that might never cause symptoms and also subjecting patients to invasive evaluations or treatments.

The authors also pointed out a paucity of st
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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
13-May-2004