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Impact of Age on Screening and Surveillance for Primary Liver Cancer

Patel, Tushar, M.B.Ch.B.; Dangell, Cheryle; Maheshwari, Shail, M.D.

American Journal of Gastroenterology: April 2006 - Volume 101 - Issue 4 - p 768–774

OBJECTIVES Although screening and surveillance for liver cancers have become established practices, the impact of age on these practices is unknown. The age at which these could be stopped, if any, is unclear. Our aims were to assess the impact of age on developing or dying from liver cancer, and to define the relative impact of prematurely stopping screening.

METHODS Actuarial life-table analyses were performed using age-stratified mortality rates for primary liver cancers, and for all other causes combined, obtained from population-based databases from the United States. The impact of prematurely stopping screening at a given age was expressed as days of life lost compared to the maximal benefit expected from lifelong screening.

RESULTS Mortality from primary liver cancers increases with age and peaks at 37 per 100,000 persons at ages 85–90 yr. However, mortality from other causes increases even more with age. Consequently, the relative proportion of deaths from primary liver cancer is maximal at 1.34% of all deaths at age 50 yr, and gradually decreases thereafter. Eighty percent of the maximal potential benefit of lifetime screening from age 45 yr is achieved by age 77 yr, and 90% by age 82 yr.

CONCLUSIONS The relative benefits from screening for primary liver cancer are reduced in the elderly due to competing risks for death despite an increasing incidence of primary liver cancer with age. The majority of societal benefit is gained from screening at younger ages, when the relative proportions of death attributable to liver cancer are the greatest.

Division of Gastroenterology, Scott and White Clinic, Texas A&M University System Health Science Center, College of Medicine, Temple, Texas

Reprint requests and correspondence: Tushar Patel, M.B.Ch.B., Division of Gastroenterology, Scott and White Clinic, Texas A&M University System Health Science Center, College of Medicine, 2401 South 31st Street, Temple, TX 76508.

Supported by the Scott, Sherwood and Brindley Foundation.

Received May 12, 2005; accepted November 17, 2005.

© The American College of Gastroenterology 2006. All Rights Reserved.
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