This Practice Corner illustrates how busy general practitioner (GPs) can use a journal club to keep up to date with the best current research, to support care decisions for individual patients, to communicate with researchers about questions for which no satisfactory evidence exists, and to improve our daily clinical work.

CLINICAL SCENARIO

A 58 year old man was diagnosed with a 7 × 6 cm liver tumor on ultrasound (US) after presenting with abdominal distension for 1 week. He was a chronic hepatitis B carrier, detected 3 years ago in an insurance health check. Yearly blood tests have been performed since then. Four months ago, both alanine transaminase (ALT) and alpha feto protein (AFP) were in the normal range (ALT =  35 IU/l; AFP = 1.25 ng/ml).

Subsequently, left hepatectomy was performed with a pathology report of hepatocellular carcinoma (HCC) TNM Stage III. In the letter, the surgeon estimated his 5 year survival rate to be 25% according to local data. His wife, daughter, and son are asymptomatic hepatitis B carriers with normal ALT. The wife and daughter are HBe Ag positive while the son is HBe Ag negative. Understandably, they are all very concerned about the risk of having HCC in the future, and they wish to be “checked” and “treated earlier.”

CLINICAL QUESTION

Working in an endemic area for chronic hepatitis B, this scenario is not uncommon. The Hong Kong Cancer Registry in 2000 showed 1584 new cases and 1424 deaths from HCC. Lifetime risk was 1 in 30 for men and 1 in 110 for women.

Our question was: in asymptomatic chronic hepatitis B carriers, will screening by AFP and/or liver US reduce mortality from liver cancer?

SEARCH STRATEGY & APPLICATION OF THE EVIDENCE

A relevant Cochrane systematic review was retrieved using the terms chronic hepatitis B, screening, and liver cancer. We were amazed at the paucity of …