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 The Task Force found no evidence that screening low-risk adults
would be beneficial. Also, it said, screening all adults would
require a lot of resources.
"For the average Canadian at average risk, don’t screen," said Task
Force member Dr. Roland Grad, who chaired the group that crafted the
new recommendation.
Hepatitis C is a blood-borne virus. According to the U.S. Centers
for Disease Control and Prevention, people with chronic hepatitis C
are often symptom-free for many years, but they can end up with
severe liver disease.
Based on its review of the evidence, published in the journal CMAJ,
the Task Force estimates a one-time screening of 100,000 Canadians
would find 199 chronic hepatitis C infections and save about 40
lives, but at a substantial cost.
The Task Force says just focusing on screening people with symptoms
and signs of hepatitis C would find 91 cases among every 100,000
Canadians.
The U.S. Preventive Services Task Force (USPSTF) - the Canadian Task
Force's counterpart in the United States - also reserves hepatitis C
screenings for people at an increased risk of infection, including
current or former injection drug users, people who were
incarcerated, and those who've spent time in places where the
infection is common.
The USPSTF also recommends one-time hepatitis C screening for anyone
born between 1945 and 1965. It says these individuals are at higher
risk for hepatitis C, possibly due to blood transfusions and other
exposures long ago.
"At the moment, we can’t make a recommendation for all Canadians
regardless of what year you were born in to be screened for
hepatitis C," said Grad, who is also affiliated with McGill
University in Montreal.
He said the prevalence of hepatitis C in Canada is different than
that of the U.S. population.
The Canadian Task Force on Preventive Health Care writes that
between 220,000 and 245,000 people in the country have a chronic
hepatitis C infection. In the U.S., the CDC puts that number at 3.1
million.
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Grad added that unlike the USPSTF, the Canadian Task Force takes
finances and resources into account when creating its
recommendations.
The Canadian Task Force says recommending against universal
screening allows the country to focus its resources on testing those
at highest risk for the infection.
Dr. Ellie Carmody, who was not involved with the new recommendation,
says the recommendation against screening may be relevant to Canada,
but the USPSTF's recommendation is right for the U.S.
"Screening in the U.S., particularly among the baby boomers, is and
continues to be a priority," said Carmody, who is an assistant
professor of infectious diseases at NYU Langone Medical Center in
New York.
"Canada is in a different circumstance and at greater resource
constraints and a lower prevalence of hepatitis C (and) that changes
the risk-benefit profile of screening," she told Reuters Health.
SOURCE: http://bit.ly/2q83PES CMAJ, online April 24, 2017.
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