A pilot study on the screening of primary hepatocellular carcinoma in selected high risk groups in the population using multiple tumour markers.

A prospective one year study on groups of 377 high risk individuals was done using alphafoetoprotein (AFP), alpha 1antitrypsin (A1AT), alpha 1-acidglycoprotein 1 (A1GP), gammaglutamyltraspeptidase (GGT) and isocitrate dehydrogenase (ICD) to detect hepatocellular carcinoma (HCC). The high risk groups screened were: cirrhosis, unexplanable hepatomegalies, chronic hepatitis B surface antigen (HBsAg) carrier, family members of afflicted HCC cases, individuals on hormonal therapy and males over the age of 30 years. 58/377 (15%) were found to have HCC. This consisted of 16/43 (37%) clinical cirrhosis, 40/71 (56%) unexplanable hepatomegalies, 1/33 (3%) chronic HBsAg, 1/156 (0.6%) family members. AFP remained the most useful test but the others such as A1AT, A1Gp, GGT and ICD recognised both malignant and asymptomatic nonmalignant diseases. Only 4 (7%) patients had resectible tumours detected and 1 patient was found to have liver dysplasia. HBsAg positivity and persistently raised AFP. The significance of HBsAg amongst family members and other group is discussed in terms of genetic susceptibility, environmental oncogenic vulnerability and ultimate screening.