News > Medscape Medical News > Conference News > International Liver Congress (ILC) 2018
Liver Cancer on the Rise in Backdrop of Undiagnosed Hep C - Neil Osterweil - April 05, 2018
PARIS - Liver cancer, one of the greatest challenges to hepatologists today, will be in the spotlight at the upcoming International Liver Congress (ILC) 2018.
It will become an even greater challenge in the near future, said Morris Sherman, PhD, from the University of Toronto, who is chair of the Canadian Liver Foundation.
"Liver cancer is increasing in most Western countries, partly because of the hepatitis C epidemic that occurred in the 1950s and 1960s," he told Medscape Medical News. "These people are now 60 to 70 years old and have had their disease a very long time. They now they are starting to come down with end-stage liver cancer."
"We're not 100% sure of this, but certainly in the United States, and probably in Canada, the majority of patients with hepatitis C have not yet been diagnosed," he added.
Although there are a handful of existing and emerging treatments for advanced hepatocellular carcinoma, they are not highly effective, he said.
"We're not going to be able to transplant everybody, so we need to be able to manage end-stage liver disease better than we currently do," Sherman explained. And there is currently a shortage of centers equipped to manage what is expected to be the burgeoning number of patients with end-stage liver cancer.
Details of new clinical practice guidelines for liver disease - including one on the management of patients with hepatocellular carcinoma - will be released by the European Association for the Study of the Liver, which is sponsoring the congress.
A session on guidelines for the management of decompensated cirrhosis and nutrition will include a panel discussion that will highlight the changes and updates that will most affect clinical practice.
Nonalcoholic Fatty Liver and Steatohepatitis - With the advent of highly effective, albeit expensive, drug regimens, there has been a decline in the use of hepatitis C infection as an indication for liver transplantation. This indicator is rapidly being replaced by nonalcoholic fatty liver and steatohepatitis.
"In the past, hepatitis C dominated liver meetings in the United States, as well as in Europe, but now we are seeing a lot more information and more drug studies about NASH and information about the natural history of nonalcoholic fatty liver disease," said Michael Fried, MD, from the University of North Carolina at Chapel Hill, who is president-elect of the American Association for the Study of Liver Diseases.
A symposium on the management of nonalcoholic fatty liver disease will address who and how to screen, noninvasive diagnostic and follow-up techniques, lifestyle interventions that can help decrease the incidence and severity of nonalcoholic steatohepatitis, and pharmacologic approaches on the near horizon.
An oral session examining nonalcoholic fatty liver disease diagnostics and noninvasive assessment will include presentations on new scoring systems for disease-related fibrosis, serum biomarkers that might help discriminate between nonalcoholic steatohepatitis and simple steatosis, and the noninvasive prediction of esophageal varices in patients with related liver cirrhosis.
Sherman, however, said he is currently skeptical about the ability of the field of hepatology to do much about this growing problem.
"Liver disease due to NASH or nonalcoholic fatty liver is getting to be a growing concern, and will likely be a major issue in the future," he told Medscape Medical News.
He noted that diagnostics and biomarkers are only relevant if actual therapies - not lifestyle interventions - are available.
"There is a growing awareness of the impact that NASH has on patients in a multisystem way," Fried said. "The interactions between diabetes and NASH, metabolic syndrome, and the impact of cardiovascular disease are all important topics. There has to be greater awareness of this, not just among hepatologists, but also among general practitioners and specialists, such as endocrinologists, who certainly will see patients who potentially have NASH."
Many Diseases, Common Symptoms
One symposium - Symptom Management Across Liver Diseases: Is There a Big Picture? - will unite clinicians and patients to address the overarching question of whether there can be a common approach to treating the symptoms of many different types of liver disease, such as fatigue, pruritus, mental health issues, and quality-of-life concerns.
Two central questions will be addressed during the symposium, which is sponsored by the European Liver Patients' Association: Are some approaches helpful to the management of symptoms across different liver diseases, regardless of diagnosis? And how do symptoms, their causes, and management options differ in relation to the underlying disease and even the individual patient?
This might be a bigger challenge than many realize, Sherman told Medscape Medical News.
"There are a variety of symptoms that have been attributed to liver disease," he noted. "Most of them are not specific and, really, the liver has so much reserve that you really only start getting symptoms that you can definitely attribute to the liver when the liver starts to fail."
Although hepatitis C infection has gotten the bulk of attention in recent years, hepatitis B virus infection "remains a major public health issue worldwide, despite the availability of an effective vaccine and potent antiviral treatments that are able to suppress viral replication," according to the congress program.
One symposium - Current Management and Emerging Treatment in HBV - will address some of the most important issues related to hepatitis B, such as the prevention and treatment of infection with limited resources, whether is it a wise strategy to stop nucleoside analogs before the hepatitis B surface antigen is lost, and upcoming immunologic and antiviral treatment strategies.
During the grand rounds session, tag teams that consist of senior faculty members from major European institutions and their junior colleagues will present challenging cases of broad interest to hepatologists, including primary biliary cholangitis, cirrhosis complications, hepatocellular carcinoma in noncirrhotic liver, fatty liver in a lean patient, and severe alcoholic hepatitis.
Follow Medscape Gastro on Twitter @MedscapeGastro and Neil Osterweil @NeilOsterweil
Canuck said
Mar 30, 2018
Just some more stats on how we are doing at getting the "boomer" sector screened. Mind you, they were using pre-2015 patients for this counting, but still, even more recent-time based articles on this subject have us in the "doing an abysmal job at screening" category. At this rate, 11-12-ish%, how can one ever reach or even project/predict our lofty world-eradication date! Can't be done at this rate of detection! (The last sentence in this article is, well, a bit of an understatement IMO).
Published in Gastroenterology
News· March 28, 2018
Hepatitis C Screening Increasing Among Baby Boomers
Screening prevalence 11.5 to 12.8 percent; similar rate for cohort born from 1966 to 1985
TUESDAY, March 27, 2018 (HealthDay News) -- For baby boomers, born between 1945 and 1965, the odds of hepatitis C virus (HCV) screening increase over time, although the rates of screening are low, according to a study published online March 27 in Cancer Epidemiology, Biomarkers & Prevention.
Monica L. Kasting, Ph.D., from the H. Lee Moffitt Cancer Center in Tampa, Fla., and colleagues assessed HCV screening rates and predictors for four birth cohorts: born before 1945, born from 1945 to 1965 (baby boomers), born between 1966 and 1985, and born after 1985. The authors used data from the 2013 to 2015 National Health Interview Surveys. In the final analytical sample, there were 15,100 participants born before 1945, 28,725 baby boomers, 28,089 born from 1966 to 1985, and 13,296 born after 1985.
The researchers found that for baby boomers, the screening rate was 11.5 to 12.8 percent. The second youngest birth cohort had a similar prevalence of screening (13.7 to 14.9), while the older birth cohort had less screening. The odds of HCV screening increased significantly with each subsequent year in the final model for baby boomers (odds ratios, 1.2 and 1.31) after participants who typically have higher rates of HCV screening than the general population were excluded. In baby boomers there was a significant association for HCV screening with age, gender, and race/ethnicity.
"While HCV screening is increasing over time, these increases are minimal and there is substantial room for improvement," the authors write ...
LamontCranston said
Jul 23, 2017
Apparently Kaiser has had a screening policy that missed me totally, even though I have been sick with what are ALL suspicious HepC symptoms for 2 years. I have had blood tests for everything, but NOT Hep C, until March, when my wife showed an anti-body positive, but no infection. I came up with a diagnosis, and my doctor is like "oh, really?"...
The more I think about all the crap I have gone through in the last couple of years, I have to wonder if she is paying attention? Not confidence inspiring, that's for sure.
Canuck said
Jul 21, 2017
IN THE JOURNALS
Survey finds gaps in HBV, HCV testing guides, outcome data
June 1, 2017
Fifteen countries reported using more than one type of approach to fund HBV and HCV testing, nine countries reported access to HBV and HCV testing with reimbursed user-fees in at least certain settings, and three reported use of non-reimbursed user fees.
While 19 and 16 countries conducted monitoring of at least one testing, diagnosis or treatment indicator of HBV or HCV, respectively, NO countries monitored either the number of HBV or HCV tests offered or the number of people offered a test.
Nine and eight countries believed there were EXISTING gaps in testing policies in their country for HBV and HCV, respectively. Seventeen countries felt that risk groups, particularly people who inject drugs, were NOT BEING TARGETED EFFECTIVELY for HBV and 16 countries felt the SAME for HCV.
..."The survey findings reveal a wide variation in testing policy and practice across the EU/EEA, and a number of significant gaps," the researchers concluded." Just over half of responding countries agreed that there is a need for European-level testing guidance, in particular guidance covering who to test, how to target those at risk, and monitoring and evaluation of testing initiatives ...
It was considered that this guidance could support the development of national guidance documents, add value to existing guidance, and would be timely, given the increasing movement of populations across national borders." - by Talitha Bennett
Canuck said
Jul 20, 2017
Need for better screening and capture (and treatment) of boomers who are HCV positive.
With just some simple measures they have improved screening, perhaps as much as from 28% to 72% (in some circumstances). Without testing, without capture, there is no cure, and certainly no eradication of the epidemic of HCV. Everything done to the system, every tweek, to test everyone, gets all of us to eradication, sooner. (I keep seeing articles that attest to the fact that professionals themselves surmize that they are, on the whole, doing a rather an abysmal job of screening people for hep B and C).
New EHR alert increases HCV screening among baby boomers
Konerman MA, et al. Hepatol. 2017;doi:10.1002/hep.29362.
July 18, 2017
... Implementation of an electronic health record-based prompt significantly increased hepatitis C screening rates among baby boomers in primary care. According to the researchers, HCV screening among adults born between 1945 and 1965 increased fivefold during a 1-year period following implementation of the Best Practice Advisory (BPA) EHR alert.
"Although there has been dramatic advances in therapy, there remain significant barriers to HCV elimination including deficiencies in screening and subsequent linkage to care," Monica A. Konerman, MD, MSc, from the University of Michigan, told Healio.com/Hepatology. "Despite evidence-based recommendations,uptake of one-time universal HCV screening among baby boomers remains low. Various approaches have been evaluated to optimize screening rates, but most fall short in their ability to confirm diagnosis and plug patients into specialty care.
The BPA alerts users when a patient is born between 1945 and 1965, lacks a prior EHR ICD-9 or ICD-10 diagnosis code for HCV, and/or lacks documented anti-HCV testing after 2009. However, the alert does not require order testing or a reason for not testing for a primary care physician (PCP) to continue in the EHR.
During the 3 yearsprior to the BPA implementation,52,660 patients in the baby boomer cohort visited a PCP at least once. Of the 28% who received HCV screening in that time, screening was performed more often among men than women (31% vs. 26%; P < .001), African-American and Asian patients than Caucasian and other ethnicities (34% and 36% vs. 27% and 29%; P < .001), and patients with Medicaid or Medicare than those with commercial insurance (34% and 32% vs. 27%; P < .001). Additionally, there were varying rates of HCV screening across clinic specialties, ranging from 19% to 34% (P < .001).
Compared with 6 months prior to BPA implementation,the rate of anti-HCV orders increasedfrom 4.6% to 47% in eligible visits and from 7.6% to 72% in eligible patients during the 1-year period after the BPA was added to EHR alerts...
From Medscape:
Liver Cancer on the Rise in Backdrop of Undiagnosed Hep C - Neil Osterweil - April 05, 2018
PARIS - Liver cancer, one of the greatest challenges to hepatologists today, will be in the spotlight at the upcoming International Liver Congress (ILC) 2018.
It will become an even greater challenge in the near future, said Morris Sherman, PhD, from the University of Toronto, who is chair of the Canadian Liver Foundation.
"Liver cancer is increasing in most Western countries, partly because of the hepatitis C epidemic that occurred in the 1950s and 1960s," he told Medscape Medical News. "These people are now 60 to 70 years old and have had their disease a very long time. They now they are starting to come down with end-stage liver cancer."
"We're not 100% sure of this, but certainly in the United States, and probably in Canada, the majority of patients with hepatitis C have not yet been diagnosed," he added.
Although there are a handful of existing and emerging treatments for advanced hepatocellular carcinoma, they are not highly effective, he said.
"We're not going to be able to transplant everybody, so we need to be able to manage end-stage liver disease better than we currently do," Sherman explained. And there is currently a shortage of centers equipped to manage what is expected to be the burgeoning number of patients with end-stage liver cancer.
Details of new clinical practice guidelines for liver disease - including one on the management of patients with hepatocellular carcinoma - will be released by the European Association for the Study of the Liver, which is sponsoring the congress.
A session on guidelines for the management of decompensated cirrhosis and nutrition will include a panel discussion that will highlight the changes and updates that will most affect clinical practice.
An oral session examining nonalcoholic fatty liver disease diagnostics and noninvasive assessment will include presentations on new scoring systems for disease-related fibrosis, serum biomarkers that might help discriminate between nonalcoholic steatohepatitis and simple steatosis, and the noninvasive prediction of esophageal varices in patients with related liver cirrhosis.
Sherman, however, said he is currently skeptical about the ability of the field of hepatology to do much about this growing problem.
"Liver disease due to NASH or nonalcoholic fatty liver is getting to be a growing concern, and will likely be a major issue in the future," he told Medscape Medical News.
He noted that diagnostics and biomarkers are only relevant if actual therapies - not lifestyle interventions - are available.
"There is a growing awareness of the impact that NASH has on patients in a multisystem way," Fried said. "The interactions between diabetes and NASH, metabolic syndrome, and the impact of cardiovascular disease are all important topics. There has to be greater awareness of this, not just among hepatologists, but also among general practitioners and specialists, such as endocrinologists, who certainly will see patients who potentially have NASH."
Many Diseases, Common Symptoms
One symposium - Symptom Management Across Liver Diseases: Is There a Big Picture? - will unite clinicians and patients to address the overarching question of whether there can be a common approach to treating the symptoms of many different types of liver disease, such as fatigue, pruritus, mental health issues, and quality-of-life concerns.
This might be a bigger challenge than many realize, Sherman told Medscape Medical News.
"There are a variety of symptoms that have been attributed to liver disease," he noted. "Most of them are not specific and, really, the liver has so much reserve that you really only start getting symptoms that you can definitely attribute to the liver when the liver starts to fail."
Although hepatitis C infection has gotten the bulk of attention in recent years, hepatitis B virus infection "remains a major public health issue worldwide, despite the availability of an effective vaccine and potent antiviral treatments that are able to suppress viral replication," according to the congress program.
One symposium - Current Management and Emerging Treatment in HBV - will address some of the most important issues related to hepatitis B, such as the prevention and treatment of infection with limited resources, whether is it a wise strategy to stop nucleoside analogs before the hepatitis B surface antigen is lost, and upcoming immunologic and antiviral treatment strategies.
During the grand rounds session, tag teams that consist of senior faculty members from major European institutions and their junior colleagues will present challenging cases of broad interest to hepatologists, including primary biliary cholangitis, cirrhosis complications, hepatocellular carcinoma in noncirrhotic liver, fatty liver in a lean patient, and severe alcoholic hepatitis.
Follow Medscape Gastro on Twitter @MedscapeGastro and Neil Osterweil @NeilOsterweil
Just some more stats on how we are doing at getting the "boomer" sector screened. Mind you, they were using pre-2015 patients for this counting, but still, even more recent-time based articles on this subject have us in the "doing an abysmal job at screening" category. At this rate, 11-12-ish%, how can one ever reach or even project/predict our lofty world-eradication date! Can't be done at this rate of detection! (The last sentence in this article is, well, a bit of an understatement IMO).
News · March 28, 2018
Hepatitis C Screening Increasing Among Baby Boomers
Screening prevalence 11.5 to 12.8 percent; similar rate for cohort born from 1966 to 1985
TUESDAY, March 27, 2018 (HealthDay News) -- For baby boomers, born between 1945 and 1965, the odds of hepatitis C virus (HCV) screening increase over time, although the rates of screening are low, according to a study published online March 27 in Cancer Epidemiology, Biomarkers & Prevention.
Monica L. Kasting, Ph.D., from the H. Lee Moffitt Cancer Center in Tampa, Fla., and colleagues assessed HCV screening rates and predictors for four birth cohorts: born before 1945, born from 1945 to 1965 (baby boomers), born between 1966 and 1985, and born after 1985. The authors used data from the 2013 to 2015 National Health Interview Surveys. In the final analytical sample, there were 15,100 participants born before 1945, 28,725 baby boomers, 28,089 born from 1966 to 1985, and 13,296 born after 1985.
The researchers found that for baby boomers, the screening rate was 11.5 to 12.8 percent. The second youngest birth cohort had a similar prevalence of screening (13.7 to 14.9), while the older birth cohort had less screening. The odds of HCV screening increased significantly with each subsequent year in the final model for baby boomers (odds ratios, 1.2 and 1.31) after participants who typically have higher rates of HCV screening than the general population were excluded. In baby boomers there was a significant association for HCV screening with age, gender, and race/ethnicity.
"While HCV screening is increasing over time, these increases are minimal and there is substantial room for improvement," the authors write ...
Apparently Kaiser has had a screening policy that missed me totally, even though I have been sick with what are ALL suspicious HepC symptoms for 2 years. I have had blood tests for everything, but NOT Hep C, until March, when my wife showed an anti-body positive, but no infection. I came up with a diagnosis, and my doctor is like "oh, really?"...
The more I think about all the crap I have gone through in the last couple of years, I have to wonder if she is paying attention? Not confidence inspiring, that's for sure.
IN THE JOURNALS
Survey finds gaps in HBV, HCV testing guides, outcome data
June 1, 2017
Fifteen countries reported using more than one type of approach to fund HBV and HCV testing, nine countries reported access to HBV and HCV testing with reimbursed user-fees in at least certain settings, and three reported use of non-reimbursed user fees.
While 19 and 16 countries conducted monitoring of at least one testing, diagnosis or treatment indicator of HBV or HCV, respectively, NO countries monitored either the number of HBV or HCV tests offered or the number of people offered a test.
Nine and eight countries believed there were EXISTING gaps in testing policies in their country for HBV and HCV, respectively. Seventeen countries felt that risk groups, particularly people who inject drugs, were NOT BEING TARGETED EFFECTIVELY for HBV and 16 countries felt the SAME for HCV.
..."The survey findings reveal a wide variation in testing policy and practice across the EU/EEA, and a number of significant gaps," the researchers concluded." Just over half of responding countries agreed that there is a need for European-level testing guidance, in particular guidance covering who to test, how to target those at risk, and monitoring and evaluation of testing initiatives ...
It was considered that this guidance could support the development of national guidance documents, add value to existing guidance, and would be timely, given the increasing movement of populations across national borders." - by Talitha Bennett
Need for better screening and capture (and treatment) of boomers who are HCV positive.
With just some simple measures they have improved screening, perhaps as much as from 28% to 72% (in some circumstances). Without testing, without capture, there is no cure, and certainly no eradication of the epidemic of HCV. Everything done to the system, every tweek, to test everyone, gets all of us to eradication, sooner. (I keep seeing articles that attest to the fact that professionals themselves surmize that they are, on the whole, doing a rather an abysmal job of screening people for hep B and C).
New EHR alert increases HCV screening among baby boomers
Konerman MA, et al. Hepatol. 2017;doi:10.1002/hep.29362.
July 18, 2017
... Implementation of an electronic health record-based prompt significantly increased hepatitis C screening rates among baby boomers in primary care. According to the researchers, HCV screening among adults born between 1945 and 1965 increased fivefold during a 1-year period following implementation of the Best Practice Advisory (BPA) EHR alert.
"Although there has been dramatic advances in therapy, there remain significant barriers to HCV elimination including deficiencies in screening and subsequent linkage to care," Monica A. Konerman, MD, MSc, from the University of Michigan, told Healio.com/Hepatology. "Despite evidence-based recommendations, uptake of one-time universal HCV screening among baby boomers remains low. Various approaches have been evaluated to optimize screening rates, but most fall short in their ability to confirm diagnosis and plug patients into specialty care.
The BPA alerts users when a patient is born between 1945 and 1965, lacks a prior EHR ICD-9 or ICD-10 diagnosis code for HCV, and/or lacks documented anti-HCV testing after 2009. However, the alert does not require order testing or a reason for not testing for a primary care physician (PCP) to continue in the EHR.
During the 3 years prior to the BPA implementation, 52,660 patients in the baby boomer cohort visited a PCP at least once. Of the 28% who received HCV screening in that time, screening was performed more often among men than women (31% vs. 26%; P < .001), African-American and Asian patients than Caucasian and other ethnicities (34% and 36% vs. 27% and 29%; P < .001), and patients with Medicaid or Medicare than those with commercial insurance (34% and 32% vs. 27%; P < .001). Additionally, there were varying rates of HCV screening across clinic specialties, ranging from 19% to 34% (P < .001).
Compared with 6 months prior to BPA implementation, the rate of anti-HCV orders increased from 4.6% to 47% in eligible visits and from 7.6% to 72% in eligible patients during the 1-year period after the BPA was added to EHR alerts...