A universal hepatitis C screening protocol for inpatients at a large cancer center led to more diagnoses and treatment and coincided with a declining likelihood of developing secondary liver cancer, according to study findings presented at The Liver Meeting 2023.

Although less than 1% of the U.S. population has chronic hepatitis C virus (HCV) infection, the Centers for Disease Control and Prevention recommended in 2020 that all adults should be screened for HCV regardless of risk factors. Even before that, oncology professional groups advised universal HCV screening for people with cancer. Over time, chronic HCV infection can cause hepatocellular carcinoma, the most common type of cancer that originates in the liver.

Harrys Torres, MD, of the University of Texas MD Anderson Cancer Center, and colleagues assessed the outcomes of a universal HCV antibody screening protocol for all new outpatients, which the center implemented in October 2016. The protocol includes provider education, electronic health record (EHR) orders and automated reminders (best practice alerts). Patients with solid tumors were targeted, as those with hematological malignancies, or blood cancers, were already being screened for HCV before the study period.

Torres and colleagues analyzed the proportion of people who underwent HCV screening and were then linked to hepatitis C care. 

From April 2016 to April 2023, 85,836 people with cancer were screened for HCV. There was a continuous increase in screening over time, except during the peak of the COVID-19 pandemic in the spring of 2020. The proportion of new outpatients screened rose from 10% during the first six months of the study period to 34% after the universal screening protocol was implemented.

Among those screened, 56,075 (65%) had solid tumors. Within this group, 1,300 (2.3%) tested positive for HCV antibodies; the prevalence was highest among people with gastrointestinal cancers (5.6%), head and neck cancers (4.0%) and thoracic or lung cancers (4.0%).

Ultimately, of the 1,300 outpatients who newly tested positive for HCV antibodies, 59% were linked to care. Of those, 73% were diagnosed with current active HCV infection. Within this group, 76% were treated with direct-acting antiviral therapy, and 97% of treated patients achieved a functional cure.

Moreover, the rate of hepatocellular carcinoma as a secondary cancer in this population dropped from 15% between 2011 and 2017 to 5.7% between 2017 and 2023, after the screening protocol was implemented.

“The prevalence of HCV remains higher in cancer patients compared to the general population,” the researchers concluded. “Universal HCV screening can be successfully implemented in cancer hospitals using an EHR-based multipronged approach. This strategy can be implemented in cancer centers nationwide to contribute to HCV elimination targets.”

Click here to read the study abstract.
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