澳大利亚的肝细胞癌监测:当前和未来展望。

IF 6.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Medical Journal of Australia Pub Date : 2024-09-08 DOI:10.5694/mja2.52440
Naomi CA Whyler, Sushena Krishnaswamy, Michelle L Giles
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引用次数: 0

摘要

致编辑我们饶有兴趣地阅读了 Hui 及其同事1 关于澳大利亚肝细胞癌 (HCC) 监控的精彩综述。1 建议对高风险人群进行监测,但监测效果并不理想;集中式监测计划可提供更好的医疗服务模式。1 然而,筛查计划可能只对那些被诊断出患有会增加 HCC 风险的疾病的人群有效。这是一个独特的群体,在澳大利亚,他们普遍接受乙型肝炎检测,2 而且往往是在年轻时首次与医疗保健系统打交道,没有其他合并症。对于那些极有可能发展为 HCC 的人群,如来自撒哈拉以南非洲、年龄超过 20 岁的妇女,产前诊断为教育提供了机会。在澳大利亚,有证据表明,在怀孕期间被诊断出患有与长期并发症相关的疾病(如妊娠糖尿病3 和妊娠高血压疾病4 )的人,在产后往往不会接受建议的后续护理。在澳大利亚,乙型肝炎患者产后继续接受护理的记录很少,但似乎与其他产前诊断的疾病类似,现有数据估计只有不到一半的患者在产后第一年内接受了乙型肝炎护理。我们建议将现有的产前筛查和诊断纳入策略中,以识别那些可能受益于 HCC 监测的高危人群,并优化产后护理路径,为这些人群提供支持。
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Hepatocellular carcinoma surveillance in Australia: current and future perspectives

To the Editor: We read with interest the excellent review by Hui and colleagues1 on hepatocellular carcinoma (HCC) surveillance in Australia. HCC is increasing in incidence in Australia, and is often diagnosed late, when curative options are limited and mortality rates are high.1 Surveillance is recommended in high risk individuals but uptake is suboptimal; a centralised surveillance program may provide an improved model of care delivery.1 However, screening programs may only be successful in those with a diagnosis of a condition that increases their risk of HCC.

Improved case-finding strategies are recommended;1 however, an important group not discussed in this article is pregnant people. This is a unique population who is universally tested for hepatitis B in Australia,2 and who is often interacting with the health care system for the first time at a young age, without other comorbid conditions. In those at high risk of progression to HCC, such as women from sub-Saharan Africa aged over 20 years, antenatal diagnosis provides an opportunity for education. Linkage to specialist care during pregnancy also enables the development of an HCC surveillance plan to maximise the opportunities for early diagnosis of complications.

There is evidence to suggest that, in Australia, people who are diagnosed during pregnancy with a medical condition that is associated with long term complications, such as gestational diabetes3 and hypertensive disorders in pregnancy,4 often do not engage in recommended follow-up care in the postpartum period. Postpartum retention in care in those with hepatitis B in Australia is poorly documented, but appears similar to other antenatally diagnosed conditions, with existing data estimating that less than half engage with hepatitis B care during the first year postpartum.5 In addition to the barriers to accessing surveillance outlined by Hui and colleagues,1 engagement in care during the postpartum period may be hampered by the need to juggle family and child care responsibilities, return to the workforce, and access to child care to allow attendance at appointments.

We recommend integrating existing antenatal screening and diagnosis into strategies to identify those at high risk who may benefit from HCC surveillance, and optimising postpartum pathways of care to support these individuals.

No relevant disclosures.

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来源期刊
Medical Journal of Australia
Medical Journal of Australia 医学-医学:内科
CiteScore
9.40
自引率
5.30%
发文量
410
审稿时长
3-8 weeks
期刊介绍: The Medical Journal of Australia (MJA) stands as Australia's foremost general medical journal, leading the dissemination of high-quality research and commentary to shape health policy and influence medical practices within the country. Under the leadership of Professor Virginia Barbour, the expert editorial team at MJA is dedicated to providing authors with a constructive and collaborative peer-review and publication process. Established in 1914, the MJA has evolved into a modern journal that upholds its founding values, maintaining a commitment to supporting the medical profession by delivering high-quality and pertinent information essential to medical practice.
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