Screening for hepatocellular carcinoma by Egyptian physicians

Table 1 Personal data of participating physicians

	n (154)	%
Age (yr)
24-35	69	45
36-45	43	28
46-65	42	27
Sex
Male	104	67.5
Female	50	32.5
Specialty
GP	3	2
Tropical Medicine	78	50
Internal Medicine	48	31
Gastroenterology	4	3
Others	21	14
Highest qualification
MBBCH	25	16
Msc	49	32
MD	69	45
Others	11	7
Clinical practice
Primary Health Care	4	3
MOH	51	33
University Hospital	95	61
Private practice	4	3

MOH: Ministry of Health.

Table 2 Relation of the physicians’ age and knowledge of hepatocellular carcinoma epidemiology

	Age (yr)				P value
	< 45		≥45
	n	%	n	%
Recommended HCC surveillance
Chronic hepatitis B, C and liver cirrhosis	94	84	39	93	0.15
Positive family history	36	32	18	43	0.215
Everyone	19	17	3	7	0.121
Reduction of deaths from HCC by screening					0.419
< 30%	25	22	12	29
≥ 30%	87	787	30	71
Risk factors for liver disease progression
Age	49	448	14	33	0.242
Regular alcohol consumption	49	44	22	52	0.339
Gender	33	29	17	40	0.194
Obesity, DM	42	37	13	31	0.45
HCV genotype	54	48	32	76	0.002a
HBV-HCV co-infection	60	54	18	43	0.236
Leading cause of HCC in Egypt					0.11
HCV	93	83	30	71
HBV	19	17	12	29
Causes of death of HCC patients					0.096
Cancer	49	44	18	43
Liver failure	34	302	19	45
GI or variceal bleeding	29	25	5	12

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 3 Relation between physicians’ specialty and knowledge of hepatocellular carcinoma epidemiology

	Specialty				P value
	Specialty A1		Specialty B2
	n	%	n	%
People who should undergo HCC surveillance
Chronic hepatitis B, C and liver cirrhosis	117	90	16	67	0.006a
Positive family history	51	39	3	12	0.112
Everyone	15	11	7	29	0.023a
Reduction of deaths from HCC by screening					0.903
< 30%	31	24	6	25
≥ 30%	99	76	18	75
Risk factors for disease progression
Age	54	41	9		0.712
Regular alcohol consumption	63	48	8	33	0.172
Gender	47	36	3	12	0.023a
Obesity, DM	50	38	5	21	0.098
HCV genotype	74	57	12	50	0.53
Co-infection	69	53	9	37	0.161
Most common cause of HCC					0.711
HCV	105	81	18	75
HBV	25	19	6	25
Cause of death of HCC patients					0.217
Cancer	59	45	8	33
Liver failure	41	32	12	50
GI or variceal bleeding	30	23	4	17

¹Specialty A (Tropical medicine, Internal medicine, Gastroenterology);

²Specialty B (General practitioner, Radiology, General surgery).

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 4 Relation between physicians’ qualification and knowledge of hepatocellular carcinoma epidemiology

	Highest qualification						P value
	MBBCH		Msc/diploma		MD
	n	%	n	%	n	%
People who should undergo HCC surveillance
Chronic hepatitis B, C and liver cirrhosis	23	92	51	85	59	85	0.666
Positive family history	8	32	10	17	36	52	0.000a
Everyone	4	16	8	13	10	14	0.948
Reduction of deaths from HCC by screening							0.581
< 30%	8	32	14	23	15	22
≥ 30%	17	68	46	77	54	78
Risk factors for progression of the disease
Age	11	44	21	35	31	45	0.49
Regular alcohol consumption	10	40	26	43	35	51	0.562
Gender	4	16	13	22	33	48	0.001a
Obesity, DM	8	32	19	32	28	41	0.525
HCV genotype	10	40	29	48	47	68	0.017a
Co-infection	9	36	28	47	41	59	0.098
Leading cause of HCC							0.053
HCV	19	76	43	72	61	88
HBV	6	24	17	28	8	12
Cause of death of HCC patients							0.427
Cancer	12	48	25	42	30	43
Liver failure	7	28	18	30	28	41
GI or variceal bleeding	6	24	17	28	11	16

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 5 Relation between hospital setting and knowledge of hepatocellular carcinoma epidemiology

	Type of hospital				P value
	University		MOH
	n	%	n	%
People who should undergo HCC surveillance
Chronic hepatitis B, C and liver cirrhosis	79	83	54	91	0.141
Positive family history	44	46	10	17	0.000a
Everyone	17	18	5	8	0.104
Reduction of deaths from HCC by screening					0.749
< 30%	22	23	15	25
≥ 30%	73	77	44	75
Risk factors for progression of the disease
Age	43	45	20	34	0.163
Regular alcohol consumption	47	49	24	41	0.287
Gender	37	39	13	22	0.029a
Obesity, DM	37	39	18	30	0.288
HCV genotype	55	58	31	52	0.516
HBV-HCV co-infection	50	53	28	47	0.532
Leading cause of HCC					0.011a
HCV	82	86	41	70
HBV	13	14	18	30
Cause of death of HCC patients					0.493
Cancer	43	45	24	41
Liver failure	34	36	19	32
GI or variceal bleeding	18	19	16	27

^aP < 0.05 considered statistically significant. MOH: Ministry of Health; HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 6 Relation between doctors’ age and knowledge about screening modalities, educational resources and guidelines

	Age (yr)				P value
	< 45		≥45
	n	%	n	%
Most important HCC screening					0.037a
Physical examination	2	2	1	3
Alpha fetoprotein	27	24	9	21
Ultrasound	65	58	32	76
CT	18	16	0	0
2nd most important HCC screening					0.175
Physical examination	2	2	0	0
Alpha fetoprotein	55	49	16	38
Ultrasound	17	15	4	10
CT	36	32	22	52
Angiography	2	2	0	0
3rd most important HCC screening					0.585
Physical examination	3	3	2	5
Alpha fetoprotein	21	19	13	31
Ultrasound	14	12	3	7
CT	55	49	18	43
Angiography	8	7	3	7
Laparoscopy	11	10	3	7
Screening interval for high risk groups					0.212
3 mo	65	58	29	69
6 mo or more	47	42	13	31
HBV treatment reduces HCC incidence					0.014a
Yes	84	75	39	93
No	28	25	3	7
Familiar with guidelines					0.205
Yes	62	55	28	67
No	50	45	14	33
HCV RNA/ALT level are HCC risk factors					0.08
Yes	57	51	28	67
No	55	49	14	33

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CT: Computer tomography.

Table 7 Relation between medical specialty and knowledge about screening modalities, educational resources and guideline

	Specialty A		Specialty B		P value
	n	%	n	%
Most important screening for HCC					0.154
Physical examination	2	2	1	4
Alpha fetoprotein	28	21	8	33
Ultrasound	82	63	15	63
CT	18	14	0	0
2nd most important screening for HCC					0.238
Physical examination	2	2	0	0
Alpha fetoprotein	64	49	7	29
Ultrasound	16	12	5	21
CT	47	36	11	46
Angiography	1	1	1	4
3rd most important screening for HCC					0.383
Physical examination	3	2	2	9
Alpha fetoprotein	27	21	7	29
Ultrasound	16	12	1	4
CT	61	47	12	50
Angiography	10	8	1	4
Laparoscopy	13	10	1	4
Screening interval for high risk group					0.010a
Every 3 mo	85	65	9	38
6 mo or more	45	35	15	62
HBV treatment reduces HCC incidence					0.139
Yes	107	82	16	67
No	23	18	8	33
Guidelines in management of HCC					0.991
Yes	76	58	14	58
No	54	42	10	42
HCV RNA/ALT risk factors for HCC					0.147
Yes	75	58	10	42
No	55	42	14	58

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CT: Computer tomography.

Table 8 Relation between highest qualification and knowledge about screening modalities, educational resources and guidelines

	Highest qualification						P value
	MBBCH		Msc/diploma		MD
	n	%	n	%	n	%
Most important screening for HCC							0.023a
Physical examination	0	0	1	2	2	3
Alpha fetoprotein	7	28	13	22	16	23
Ultrasound	14	56	33	55	50	73
CT	4	16	13	22	1	1
2nd most important examination in screening of HCC							0.585
Physical examination	1	4	1	2	0	0
Alpha fetoprotein	12	48	26	43	33	48
Ultrasound	2	8	11	18	8	12
CT	9	36	22	37	27	39
Angiography	1	4	0	0	1	1
3rd most important screening for HCC							0.004a
Physical examination	1	4	3	5	1	1
Alpha fetoprotein	3	12	14	23	17	25
Ultrasound	6	24	2	3	9	13
CT	12	48	25	42	36	52
Angiography	1	4	4	7	6	9
Laparoscopy	2	8	12	20	0	0
Screening interval for high risk group							0.050a
Every 3 mo	15	60	30	50	49	71
6 mo or more	10	40	30	50	20	29
HBV treatment reduces HCC incidence							0.441
Yes	20	80	45	75	58	84
No	5	20	15	25	11	16
Guidelines in management of HCC							0.000a
Yes	13	52	20	33	57	83
No	12	48	40	67	12	17
HCV RNA/ALT risk factors for HCC							0.368
Yes	14	56	37	62	34	49
No	11	44	23	38	35	51

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; CT: Computer tomography.

Table 9 Relation between health care setting and knowledge about screening modalities, educational resources and guidelines

	Health care setting				P value
	University		MOH
	n	%	n	%
Most important screening for HCC					0.000a
0.000a	3	3	0	0
Alpha fetoprotein	19	20	17	29
Ultrasound	70	74	27	46
CT	3	3	15	25
2nd most important screening for HCC					0.799
Physical examination	1	1	1	2
Alpha fetoprotein	47	49	24	40
Ultrasound	11	12	10	17
CT	35	37	23	39
Angiography	1	1	1	2
3rd most important screening for HCC					0.001a
Physical examination	2	2	3	5
Alpha fetoprotein	23	24	11	19
Ultrasound	10	11	7	12
CT	52	55	21	36
Angiography	7	8	4	7
Laparoscopy	1	1	13	22
Screening interval for high risk group					0.173
Every 3 mo	62	65	32	54
6 mo or more	33	35	27	46
HBV treatment reduces HCC incidence					0.011a
Yes	82	86	41	69
No	13	14	18	31
Guidelines in management of HCC					0.000a
Yes	73	77	17	29
No	22	23	42	71
HCV RNA/ALT are risk factors for HCC					0.139
Yes	48	51	37	63
No	47	49	22	37

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MOH: Ministry of Health; CT: Computer tomography.

Table 10 Relation between physicians’ age and hepatocellular carcinoma screening

	Age (yr)				P value
	< 45		≥ 45
	n	%	n	%
HCC surveillance					0.013
Yes	20	18	15	35
No	92	82	27	65
Screening of patients with HCV cirrhosis and SVR					0.661
Yes	94	4	34	81
No	18	16	8	19
Screening of patients with hemochromatosis					0.11
Yes	73	65	33	79
No	39	35	9	21
No. of incidental HCCs/month					0.087
0	34	30	7	17
1 or more	78	0	35	83
No. of HCCs/month					0.193
0	33	29	8	19
1 or more	79	71	0.000a	81

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HBV: Hepatitis B virus; HCV: Hepatitis C virus; SVR: Sustained virological response.

Table 11 Hepatocellular carcinoma screening depending on medical specialty

	Specialty				P value
	Specialty A1		Specialty B2
	n	%	n	%
HCC surveillance					0.193
Yes	32	25	3	13
No	98	75	21	87
Screening of patients with HCV cirrhosis and SVR					0.79
Yes	109	84	19	79
No	21	16	5	21
Screening of patients with hemochromatosis					0.030a
Yes	94	72.3	12	50
No	36	27.7	12	50
No. of incidental HCCs/month					0.418
0	33	25	8	33
1 or more	97	75	16	67
No. of HCCs/month					0.759
0	34	26	7	29
1 or more	96	74	17	71

^aP < 0.05 considered statistically significant.

¹Specialty A (Tropical medicine, Internal medicine, Gastroenterology);

²Specialty B (General practitioner, Radiology, General surgery). HCC: Hepatocellular carcinoma; SVR: Sustained virological response; HCV: Hepatitis C virus.

Table 12 Hepatocellular carcinoma screening depending on highest medical qualification

	Highest qualification						P value
	MBBCH		Msc/diploma		MD
	n	%	n	%	n	%
HCC surveillance							0.0423
Yes	5	20	10	17	17	25
No	20	80	50	83	52	75
Screening of patients with HCV cirrhosis and SVR							0.638
Yes	20	80	52	87	56	81
No	5	20	8	13	13	19
Screening of patients with hemochromatosis							0.012a
Yes	15	60	35	58	56	81
No	10	40	25	42	13	19
No. of incidental HCCs/month							0.000a
0	11	44	24	40	6	9
1 or more	14	56	36	60	63	91
No. of HCC patients							0.000a
0	9	36	29	48	3	4
1 or more	16	64	31	52	66	96

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; SVR: Sustained virological response.

Table 13 Hepatocellular carcinoma C screening depending on health care setting

	Health care setting				P value
	University hospital		MOH
	n	%	n	%
HCC surveillance					0.178
Yes	25	26	10	17
No	70	74	49	83
Screening of patients with HCV cirrhosis and SVR					0.386
Yes	77	81	51	86
No	18	19	8	14
Screening of patients with hemochromatosis					0.196
Yes	69	73	37	63
No	26	27	22	37
No. of incidental HCCs/month					0.000a
0	10	10	31	53
1 or more	85	90	28	47
No. of HCCs/month					0.000a
0	9	10	32	54
1 or more	86	90	27	46

^aP < 0.05 considered statistically significant. HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; SVR: Sustained virological response; MOH: Ministry of Health.