Table 1:
Survey on HCC screening practices in chronic HBV patients among Canadian physicians
| Specialty | Years of practice | Approximate no. of HBV patients seen per year | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Question | All | HEP | GI, ID | p | ≤ 5 | 6–20 | ≥ 21 | p | < 10 | 10–99 | ≥ 100 | p |
| Do you treat and follow your HBV patients? | .077 | .783 | < .001 | |||||||||
| No | 7 (9.9) | 1 (2.7) | 5 (17.9) | 1 (5.0) | 3 (11.1) | 3 (12.5) | 6 (37.5) | 1 (3.7) | 0 (0.0) | |||
| Yes | 64 (90.1) | 36 (97.3) | 23 (82.1) | 19 (95.0) | 24 (88.9) | 21 (87.5) | 10 (62.5) | 26 (96.3) | 28 (100.0) | |||
| Do you have access to transient elastography (Fibrocan)? | .030 | .121 | .057 | |||||||||
| No | 6 (8.5) | 0 (0.0) | 4 (14.3) | 4 (20.0) | 1 (3.7) | 1 (4.2) | 3 (18.8) | 3 (11.1) | 0 (0.0) | |||
| Yes | 65 (91.5) | 37 (100.0) | 24 (85.7) | 16 (80.0) | 26 (96.3) | 23 (95.8) | 13 (81.3) | 24 (88.9) | 28 (100.0) | |||
| Which would best describe your HCC screening practice? | .087 | .937 | .244 | |||||||||
| Automatic recall of patients for US every 6 mo | 20 (28.2) | 13 (35.1) | 5 (17.9) | 7 (35.0) | 7 (25.9) | 6 (25.0) | 4 (25.0) | 9 (33.3) | 7 (25.0) | |||
| Follow patients and order US during clinic visits every 6 mo | 48 (67.6) | 24 (64.9) | 21 (75.0) | 13 (65.0) | 19 (70.4) | 16 (66.7) | 10 (62.5) | 17 (63.0) | 21 (75.0) | |||
| Refer back to primary care physician to take over HCC screening | 2 (2.8) | 0 (0.0) | 2 (7.1) | 0 (0.0) | 1 (3.7) | 1 (4.2) | 2 (12.5) | 0 (0.0) | 0 (0.0) | |||
| None of the above | 1 (1.4) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (4.2) | 0 (0.0) | 1 (3.7) | 0 (0.0) | |||
| Do you include AFP with US screening? | .969 | .327 | .088 | |||||||||
| No | 32 (45.1) | 17 (45.9) | 13 (46.4) | 11 (55.0) | 13 (48.1) | 8 (33.3) | 4 (25.0) | 16 (59.3) | 12 (42.9) | |||
| Yes | 39 (54.9) | 20 (54.1) | 15 (53.6) | 9 (45.0) | 14 (51.9) | 16 (66.7) | 12 (75.0) | 11 (40.7) | 16 (57.1) | |||
| How do you screen non-Asian non-African HBV patients? | .179 | .107 | .910 | |||||||||
| Missing | 2 | 0 | 1 | 1 | 1 | 0 | 1 | 1 | 0 | |||
| Same as Asian population | 32 (46.4) | 16 (43.2) | 13 (48.1) | 7 (36.8) | 9 (34.6) | 16 (66.7) | 7 (46.7) | 11 (42.3) | 14 (50.0) | |||
| Screen only cirrhotic patients | 12 (17.4) | 10 (27.0) | 2 (7.4) | 4 (21.1) | 6 (23.1) | 2 (8.3) | 2 (13.3) | 5 (19.2) | 5 (17.9) | |||
| US every 12 mo, start at older age | 2 (2.9) | 0 (0.0) | 2 (7.4) | 1 (5.3) | 0 (0.0) | 1 (4.2) | 0 (0.0) | 0 (0.0) | 2 (7.1) | |||
| US every 12 mo, start at same age | 6 (8.7) | 3 (8.1) | 3 (11.1) | 0 (0.0) | 4 (15.4) | 2 (8.3) | 1 (6.7) | 3 (11.5) | 2 (7.1) | |||
| US every 6 mo, start at older age | 17 (24.6) | 8 (21.6) | 7 (25.9) | 7 (36.8) | 7 (26.9) | 3 (12.5) | 5 (33.3) | 7 (26.9) | 5 (17.9) | |||
| How do you screen young (age < 40) non-African HBV patients with a family history of HCC? | .660 | .227 | .092 | |||||||||
| Missing | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | |||
| Same as without a family history of HCC | 20 (28.6) | 10 (27.0) | 6 (22.2) | 7 (36.8) | 6 (22.2) | 7 (29.2) | 6 (40.0) | 10 (37.0) | 4 (14.3) | |||
| US and AFP every 6 mo, regardless of age | 17 (24.3) | 11 (29.7) | 5 (18.5) | 3 (15.8) | 9 (33.3) | 5 (20.8) | 2 (13.3) | 4 (14.8) | 11 (39.3) | |||
| US every 6 mo, regardless of age | 24 (34.3) | 13 (35.1) | 11 (40.7) | 6 (31.6) | 8 (29.6) | 10 (41.7) | 5 (33.3) | 11 (40.7) | 8 (28.6) | |||
| US and AFP every 12 mo, regardless of age | 4 (5.7) | 1 (2.7) | 2 (7.4) | 3 (15.8) | 0 (0.0) | 1 (4.2) | 2 (13.3) | 0 (0.0) | 2 (7.1) | |||
| US every 12 mo, regardless of age | 5 (7.1) | 2 (5.4) | 3 (11.1) | 0 (0.0) | 4 (14.8) | 1 (4.2) | 0 (0.0) | 2 (7.4) | 3 (10.7) | |||
| How do you screen HBV patients with concomitant NAFLD? | .360 | .602 | .871 | |||||||||
| Same as other chronic HBV patients | 36 (50.7) | 19 (51.4) | 15 (53.6) | 8 (40.0) | 14 (51.9) | 14 (58.3) | 9 (56.3) | 12 (44.4) | 15 (53.6) | |||
| US every 6 mo, regardless of age if have advanced hepatic fibrosis | 24 (33.8) | 15 (40.5) | 7 (25.0) | 10 (50.0) | 7 (25.9) | 7 (29.2) | 5 (31.3) | 9 (33.3) | 10 (35.7) | |||
| US every 6 mo, regardless of age and stage of hepatic fibrosis | 8 (11.3) | 2 (5.4) | 4 (14.3) | 2 (10.0) | 4 (14.8) | 2 (8.3) | 1 (6.3) | 5 (18.5) | 2 (7.1) | |||
| MRI every 6 mo, regardless of age if have advanced hepatic fibrosis | 3 (4.2) | 1 (2.7) | 2 (7.1) | 0 (0.0) | 2 (7.4) | 1 (4.2) | 1 (6.3) | 1 (3.7) | 1 (3.6) | |||
| Which is the main obstacle to HCC screening in your practice? | .172 | .617 | .296 | |||||||||
| Missing | 1 | 0 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | |||
| Lack of automatic recall system | 30 (42.9) | 12 (32.4) | 16 (59.3) | 10 (52.6) | 9 (33.3) | 11 (45.8) | 10 (66.7) | 12 (44.4) | 8 (28.6) | |||
| Limited accessibility to US, CT, or MRI at recommended intervals | 12 (17.1) | 8 (21.6) | 3 (11.1) | 1 (5.3) | 7 (25.9) | 4 (16.7) | 2 (13.3) | 3 (11.1) | 7 (25.0) | |||
| Patient non-compliance | 21 (30.0) | 12 (32.4) | 7 (25.9) | 6 (31.6) | 9 (33.3) | 6 (25.0) | 3 (20.0) | 9 (33.3) | 9 (32.1) | |||
| Other | 7 (10.0) | 5 (13.5) | 1 (3.7) | 2 (10.5) | 2 (7.4) | 3 (12.5) | 0 (0.0) | 3 (11.1) | 4 (14.3) | |||
* p value was based on χ 2 or Fisher’s exact test as appropriate.
HCC = hepatocellular carcinoma; HBV = hepatitis B virus; HEP = hepatology; GI = gastroenterology; ID = infectious disease; US = ultrasound; AFP = alpha–fetoprotein; NAFLD, non-alcoholic fatty liver disease; CT = computed tomography