HCV, Breast Cancer Screening Integration Aids Diagnosis, Linkage to Care

Magdalena Meszaros, MD

Credit: ResearchGate

Findings from a recent study suggest incorporating hepatitis C virus (HCV) screening into breast cancer screening programs may offer a viable strategy for improving engagement with the care cascade and linkage to direct-acting antiviral (DAA) treatment among older female patients.¹

The prospective, cross-sectional, multicenter study was conducted across 4 radiology centers in France and showed integrating HCV screening was well accepted among patients and resulted in prompt linkage to care with successful treatment outcomes.¹

“The implementation of effective screening programs represents a cornerstone in the path toward HCV elimination,” Magdalena Meszaros, MD, of the department of hepato-gastroenterology at Montpellier University Hospital Center, and colleagues wrote.¹ “Our study, conducted in the context of a national breast cancer screening program, responds to the imperative of increasing HCV awareness and diagnosis.”

With an estimated global 50 million people having chronic HCV infection, the World Health Organization recommends that testing, care, and treatment be provided by trained non-specialist doctors and nurses using simplified service delivery with decentralization, integration, and task shifting. It is recommended that care be provided in settings that are more accessible and convenient for patients, but little is known about the effect of such an approach in the context of breast cancer screening.²

To assess patients’ acceptance of integrated HCV screening and the subsequent impact of this approach on linkage to care, investigators proposed HCV screening to consecutive female patients 50 - 74 years of age undergoing mammography at 4 radiology centers in Montpellier, France, between March 2022 and March 2023. Patients without health insurance or who refused or did not provide informed consent were excluded.¹

A rapid diagnostic test for HCV antibodies (HCV Ab) was performed on capillary whole blood. If positive, the patient immediately received a prescription to undergo a complete blood test, including HCV Ab testing and HCV RNA detection. If HCV RNA was detected, investigators scheduled an appointment with a hepatologist to perform transient elastography and start HCV treatment. Participants also completed a questionnaire on demographic characteristics, history of exposure to potential risk factors associated with HCV transmission, prior diagnosis of HCV infection, and current employment status.¹

In total, 1500 patients with a mean age of 61.26 (±7.07) years were included in the study. Patient acceptability for coupling HCV detection to breast cancer screening was 82.40% (95% CI, 80.38%–84.30%) while 264 (17.6%) patients declined to undergo coupled mammography and HCV Ab detection on the same day. Investigators noted the main reasons for refusing HCV Ab detection were recent HCV testing (54.3%) or not feeling at risk of HCV (17%).¹

Among patients who responded to the proposed questionnaire (n = 1036), the top self-identified risk factors were blood product transfusion before 1992 (14.18%), history of tattooing (14.34%), and intravenous drug use (0.29%).¹

Among the 1236 patients who accepted coupled HCV and breast cancer screening, 8 patients had a positive HCV Ab. HCV seroprevalence in this population was 0.65%, (95% CI, 0.03%–1.27%). Of these patients, 1 declined HCV RNA testing and was lost to further follow-up. Among the 7 remaining patients with positive HCV Ab detected by rapid diagnostic test, 6 had undetectable HCV RNA and serological confirmation of HCV Ab and were thus categorized as resolved infections.¹

A single patient had detectable HCV RNA and was rapidly seen in a hepatology consultation. As self-reported risk factors, the patient underwent a cesarean section followed by a blood transfusion before 1992. The patient was immediately treated with combined sofosbuvir/velpatasvir for 12 weeks and eventually achieved HCV cure.¹

Investigators outlined multiple limitations to these findings, including potential biases introduced by the fact that breast cancer screening is usually performed by women who are already engaged in a healthcare system; the focus on HCV Ab detection omitting rapid tests for HBV and HIV; and potential lack of generalizability to low-income countries where resources and infrastructure for healthcare services, including HCV screening, are limited.¹

“Our study supports the high acceptability of coupling HCV screening by rapid diagnostic testing with breast cancer screening. Incorporating HCV screening into existing screening campaigns advances diagnosis rates, aiding global HCV elimination goals and underscoring its role in preventive medicine,” investigators concluded.¹

References:

1. ^{Meszaros M, Coursier S, Nagot N, et al. Screening for hepatitis C virus at the time of mammography using rapid diagnostic tests in women aged between 50 and 74 years (Mamm'OC NCT05067374). Journal of Viral Hepatitis. https://doi.org/10.1111/jvh.13947}
2. ^{World Health Organization. Hepatitis C. Newsroom. April 9, 2024. Accessed May 17, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c}