A survey of 177 doctors from three academic centers, sponsored by the Cleveland Clinic Foundation, found most of them use unreliable alpha fetoprotein (AFP) blood tests to screen for liver cancer instead of using more accurate ultrasounds.
Current medical guidelines call for doctors to use ultrasounds or imaging technology to screen patients at high risk of liver cancer, including those with HBV-related inflammation or cirrhosis.
Ultrasound has a sensitivity for identifying liver tumors that range from 65% to 80%, depending on the operator. Obesity and cirrhosis can often make tumors or lesions harder to find. (1)
AFP tests are performed on a blood sample, and above-normal AFP readings can indicate the presence of liver cancer. However, AFP's accuracy is much lower than ultrasounds, running under 60%. Additionally, AFP tests have even lower accuracy in certain patient populations. (1)
Despite these medical guidelines, many medical faculty members and residents relied on AFP tests for semi-annual cancer screenings instead of ultrasound technology.
Among those who performed liver cancer screening in patients with hepatitis B and C-related cirrhosis every six months, 35% of them used AFP tests and only 22% used ultrasound imaging tests.
"Further, 22 physicians (12.4%) did not check for serum AFP levels and 33 (18.6%) never used imaging to screen for liver cancer," researchers reported in the January 2015 issue of Gastroenterology Reports. (2)
"The majority of the participating physicians screen high-risk patients for liver cancer," they concluded. "However, the most appropriate modality of screening (i.e. imaging) is not employed by most physicians and there is greater reliance on AFP levels."
