Regular tumor screenings for people with cirrhosis can save lives, doctors at the UT Southwestern Medical Center have concluded after reviewing dozens of research studies.
Writing in the Public Library of Science Medical Journal, liver specialist Amit Singal and his colleagues report that people with cirrhosis who undergo regular screenings have a longer three-year survival rate after liver tumors are found than those who don’t.
Regular screenings raise the odds that liver tumors will be found early, making successful surgical treatment of the cancers or liver transplant possible, according to Singal, the medical director of the Liver Tumor Clinic in the UT Southwestern Harold C. Simmons Cancer Center, in Dallas.
“Unfortunately, right now, only a minority of patients’ cancers are found at an early stage,” Singal said.
While a safe and easy abdominal ultrasound exam can detect liver tumors, less than 20 percent of at-risk people, including those with cirrhosis, undergo the test, “largely due to providers failing to order it,” Singal said.
Singal hopes his study, based on the review of 47 research studies involving some 15,000 people, will convince more doctors to have cirrhosis patients screened for tumors. Cirrhosis is an established liver cancer risk factor.
The UT Southwestern review of the previous studies, called a meta-analysis, found that the three-year survival rate for liver cancer patients who had been regularly screened was 58 percent, compared to 28 percent among patients who weren’t screened.
In addition, the study showed that patients who were regularly screened were more likely to receive curative treatments, while unscreened patients were more likely to receive only palliative, end-of-life care.
Rick Curiel, a 60-year-old man from Forney, Texas, with cirrhosis, credits screenings with saving his life. In 2012 an exam found tumors in Curiel’s liver. Initially, Curiel underwent surgical treatment of his tumors and then a liver transplant in 2013.
“Without the screening, they wouldn’t have discovered it,” Curiel said of his liver cancer. “I am living proof that this works.”
After recovering from the transplant, Curiel has gone back to work as a hardwood floor installer.
There aren’t more people like Curiel, Singal says, because the U.S. Preventive Services Task Force has not endorsed regular liver tumor screenings for cirrhosis patients because a full randomized clinical study has not proven the screenings will save lives. The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine.
According to Singal, an attempt in 2005 to conduct such a trial failed because no one wanted to be in the study group that didn’t receive screenings.
Singal is trying to convince the medical profession the lack of a randomized trial doesn’t mean there isn’t a benefit from regular liver screenings.
“We’re stuck in the middle ground where we’ve gone halfway,” he said. “People are starting to believe liver cancer screening is helpful, but there’s not enough evidence to prove a definite benefit.”