Early detection of primary hepatocellular carcinoma. Screening for primary hepatocellular carcinoma among persons infected with hepatitis B virus

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Abstract
High rates of hepatitis B virus infection and primary hepatocellular carcinoma are present among Alaskan Natives. To determine if primary hepatocellular carcinoma could be detected at an early surgically resectable stage, serological screening for elevated .alpha.-fetoprotein levels was done semiannually among Alaskan Natives infected with hepatitis B virus. During a 26-month screening period, 3,387 .alpha.-fetoprotein tests were performed on 1,394 persons. Of 126 persons with elevated levels of .alpha.-fetoprotein (> 25 ng/mL), nine males were found to have primary hepatocellular carcinoma (all with .alpha.-fetoprotein levels > 350 ng/mL). Six of these nine persons were asymptomatic for primary hepatocellular carcinoma and four had small tumors (< 6 cm) that were surgically resected. After surgery, the .alpha.-fetoprotein levels in all four patients fell to normal and have remained normal after a follow-up of four to 20 months (median, ten months). .alpha.-Fetoprotein screening proved to be an effective approach in this population in detecting primary hepatocellular carcinoma at a potentially curable stage and should be considered in other individuals or populations infected with hepatitis B virus.