Baby Boomers Should Be Screened For Hepatitis C

Last month, the U.S. Preventive Services Task Force released a new recommendation urging baby boomers, people born between 1945 and 1965, to be screened at least once in adulthood for Hepatitis C (HCV).

The announcement comes after it was discovered that many cases of HCV in adults – a serious viral infection that predisposes people to liver disease, including severe scarring and liver cancer – are found in people born during those two decades. In the general population, a percentage of adults carry the antibodies, signaling that they have been exposed to the virus at some point in the past. The majority of these cases are found in baby boomers.

Because HCV can remain dormant without causing liver damage for years, and because physicians do not treat people until they become symptomatic or develop abnormalities suggesting active liver problems, there is no direct evidence suggesting that screening can improve outcomes. On the other hand, it is clear that treating the virus, once active, does help considerably.

A quick web search about HCV will reveal that it is associated with a number of  “risk factors” or behaviors and characteristics that predispose a person to contracting the virus. Exposure through the skin is highly correlated with the disease, injection drug use being the most significant, followed by hemophilia (from increased risk of bleeding), hemodialysis (use of long-term catheters that continually expose patients to external environments), and presence of tattoos. People who have had blood transfusions, particularly before 1992 when institutions started routinely screening for the virus, and high-risk sexual behaviors (multiple partners, unprotected sex, etc.) are also at increased risk.

The limitation of screening based on risk factors – and therefore the need to screen all adults – is that some people without any identifiable risk factors test positive for HCV antibodies. It’s unclear exactly why this occurs, although in some cases it could due to blood transfusions that patients do not remember receiving, unknown skin exposures, or transmission at birth (maternal-fetal transmission).

Regardless, one thing is clear: HCV has caused a growing burden on the health of our adult population. The virus is the number one reason that adults require liver transplants, and it has been linked to a large portion of new cases of aggressive liver cancer (hepatocellular carcinoma). While treatment decreases the risk of liver scarring and cancer dramatically, physicians are looking to improve these numbers by using exciting, new treatments that have come out in the last few years. Though the assertion has been met with some understandable skepticism, some believe that new HCV treatments could eradicate the virus completely.

In the meantime, all patients born between 1945 and 1965 should talk with their doctors about one-time HCV screening. Antibodies are measured in the blood and can be obtained at your next physical exam or wellbeing visit, together with other preventive health testing.

Positive test results do not necessarily mean you have active infection, and this should be followed up with further testing. Moreover, if you have symptoms, other abnormal lab results, or questions in general about Hepatitis C, you should discuss and consider more frequent monitoring with your primary care physician.