I spoke with my specialist, and they mentioned that I will need to get my liver enzymes, viral load, as well as core and surface antigens tested every 3 months. I inquired about annual liver imaging and was told that it’s not necessary until the age of 50, unless I have a direct family member with HCC. My parents do not have HCC, but even if they do, it’s likely that I’d find out a little too late because my dad refuses to go see the doctor. Unfortunately, my grandma – his mom, was recently diagnosed with stage 4 HCC in her early 70s. Even after informing my specialist that my grandma has been diagnosed with HCC, she insists that it wouldn’t be necessary.
What are your thoughts on this? Is it possible for my liver enzymes to come back normal but still develop HCC?
Hi @optimisticmama ,
That is strange. I get an ultrasound done every 6 months for some years now. Where are you located? Unless this is due to insurance, but I am not aware of any guidelines stating so. HBV patients either get an abdominal ultrasound every 6 months or annually.
Dear @optimisticmama, great question and the truth is this is different across the world and is also different depending on where you are from (as risk of HCC is different among people with different backgrounds). For example, people from sub-Saharan Africa may have higher risks of HCC when younger (we don’t know exactly why, but some factors include exposure to aflatoxin through peanuts), which would justify screening younger patients with ultrasound. Indeed this is reflected in the Australian guidelines around HCC screening, where the age of when people are starting to be screened differ depending on ethnicity (MAGICapp - Making GRADE the Irresistible Choice - Guidelines and Evidence summaries).
It also will depend on whether you have underlying cirrhosis or not. If you have cirrhosis, then there is a higher chance of you getting HCC (compared to if you don’t have cirrhosis). This will also be factored into the decision as to whether to screen.
Different countries also have different practices - when I was in Germany, I had a fibroscan and ultrasound every 6 months whereas this is not the norm in Australia.
Where abouts are you located? I’m in Australia and doing annual liver ultrasounds in my 40s. I’m from SE Asia and have had a maternal uncle die from HCC so may be why I’m being tested earlier. Maybe having a grandmother with HCC is further removed compared to an uncle? Just guessing here as guidelines do appear different worldwide which can be a bit frustrating. All the best.
I live in the US, and I have ultrasounds once a year. My doctor says that will increase to every 6 months when I turn 50. That’s still 20 years away for me, but that’s what we do. I have no knowledge of my family history, as I’m adopted, so I don’t think they’re screening me extra because of family history.
I’m in Australia was told twice a year by liver doctor.
I would have been in my forties
Even had to travel 400+kms, twice a year .
Thankfully monitored by GP now.
I live in the US and get an ultrasound twice a year (every 6 months), and the same with labs. I have been getting ultrasounds since 2015 (in my early-mid 30s), as an African, the predisposition risk is high, so my doctor wanted to make sure we are doing our best with monitoring. Twice a year it’s been for me. Bansah1
Australian guidelines have suggested that men of Asian background with chronic hepatitis B have increased risk of HCC when 40 years of age or older (Table 9 - Hepatitis B related hepatocellular carcinoma - B Positive ), even without cirrhosis. So they recommend ultrasound screening starting from then.
That is interesting. Because I have spoken to some hepatologist here who would start screening early. There have been cases of teenagers and young adults developing HCC, among the predisposed population or ethnicity groups. I bet we have similar guidelines here, but because of this differences in biology, some start screening early.
It’s very interesting how each country tackles these issues. Thanks for sharing.
Bansah1.
I live in the US and I have ultrasound and liver panel every 6 months. Starting this year, I plan to also get quantification of HBeAg and HBsAg in my home country as well annually.