Lucy Mathew, NP: The Importance of Liver Cancer Screening, Barriers to Surveillance

The 6th most common cancer worldwide and a leading cause of cancer deaths in the US, liver cancer is often caused by advanced liver disease that has progressed to cirrhosis, underscoring the importance of screening in this patient population.

At the 2024 annual Gastroenterology and Hepatology Advanced Practice Providers (GHAPP) conference in National Harbor, Maryland, Lucy Mathew, NP, a nurse practitioner at Cedars-Sinai, gave a presentation on liver cancer and variceal screening in patients with advanced hepatic disease, calling attention to the importance of routine screening in this population, especially in the presence of cirrhosis.

“In [patients with advanced liver disease], liver cancer surveillance is extremely important, because if detected early, we have very good treatment for it. However, if detected late, …treatment and choices are limited. It’s the same with the variceal screening, that a massive variceal bleed has a very high chance of mortality, but if we check for them, we can prevent that from happening,” Mathew told HCPLive.

She explained how patient compliance often acts as a barrier to many surveillance programs because they do not see or understand the importance of screening. Thus, Mathew recommends all healthcare providers educate their patients on the need for routine screening and additionally encourages them to set reminders in their electronic medical records to remind patients to get screened.

Mathew noted that although alpha-fetoprotein is a blood test traditionally used for liver cancer screening, the emergence of a new blood test biomarker with the hepatocellular carcinoma (HCC) panel including alpha-fetoprotein, alpha-fetoprotein-L3, and des-gamma-carboxy prothrombin, has facilitated the early detection of liver cancer. However, she pointed out insurance coverage has been an issue, and many patients cannot afford to pay hundreds of dollars every 6 months to get this screening done.

“We are in a dilemma right now as to whether we should just go with the alpha-fetoprotein or we should do the HCC panel, because we know the HCC panel is what is right for the patient, but at the same time, we don't want the patient to have the burden of that financial responsibility,” Mathew explained, referencing instances where alpha-fetoprotein and ultrasound were normal but the HCC panel showed abnormal results in her patients.

Reference

1. ^{American Liver Foundation. Liver Cancer. About Your Liver. September 12, 2023. Accessed September 17, 2024. https://liverfoundation.org/about-your-liver/facts-about-liver-disease/liver-cancer/}