New York Times (11.26.12)
The United States Preventive Services Task Force in a draft opinion said that clinicians may consider offering hepatitis C screening to adults born between 1945 and 1965 (baby boomers), but did not give strong support to the recommendation. This is short of CDC’s recommendation in August that all adults in the age group should get a one-time test to determine if they are infected with the hepatitis C virus (HCV). The task force is composed of outside experts appointed by the government. If the task force had given a stronger recommendation, health insurers would have been required to pay for the testing under the 2010 Affordable Care Act.
Martha B. Saly, director of the National Viral Hepatitis Roundtable, a coalition of more than 200 groups dedicated to eradicating hepatitis, commented that the recommendation could derail the hard work that CDC has done to prove the case that it is important for baby boomers to get a one-time HCV test. CDC declined to comment as the opinion was a draft.
According to CDC, about 3 million Americans are infected with HCV, but 45 to 85 percent are unaware of their infection. HCV can cause liver damage and liver cancer in some people decades after the initial infection. About 15,000 individuals a year die from hepatitis. Previously, CDC recommended screening for at-risk persons, such as intravenous drug users or individuals who had received blood transfusions prior to 1992. However, many cases were missed because people did not remember risky behaviors or did not inform their doctors. Recently, CDC recommended all baby boomers be tested. The 3 percent of this age group that is infected with HCV account for three quarters of all cases. Screening should detect more than 800,000 infections, which could be treated to prevent liver disease and about 120,000 deaths.
The report took into consideration that CDC’s recommendation was based partly on computer models and may have overestimated the number of cases or deaths that could be prevented.
The task force acknowledged that there would be a small benefit from screening baby boomers and gave the recommendation a grade of C, which means that for most individuals without signs or symptoms, there is likely to be little benefit from screening. The draft is posted on the task force Web site, http://www.uspreventiveservicestaskforce.org/, and is open for comment until December 24.
The report, “Screening for Hepatitis C Virus Infection in Adults: A Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation,” is published online in the journal Annals of Internal Medicine, 27 November 2012 (DOI: 10.7326/0003-4819-158-2-201301150-00574).