Primary hepatocellular carcinoma (PHC) is one of the most common cancers in the world. Clinically identified tumors are uniformly lethal. However, a high-risk population for PHC has been defined, and a serological marker identified. At high risk are chronic carriers of hepatitis B virus (HBV), and rises in the serum alpha fetoprotein (AFP) levels indicate early PHC's Such tumors are small and easily resectable; the patients have a good prognosis. Therefore, PHC presents a unique opportunity to develop a model cancer control research program. This project details a program for the secondary prevention of liver cancer based on a two-step approach: 1) identification of the HBV carriers; and 2) monitoring the AFP levels of HBV carriers. Characteristic changes in AFP levels allow PHC's to be detected at an early, respectable stage. The objectives of the program are the following. 1) To identify 5,000 HBV carriers within the east Asian populations of the Philadelphia area. East Asian Populations have high HBV carrier rates and are therefore, the focus of the screening effort. 2) To detect 10 resectable PHC's per year among the monitored population. 3) To compare the survival of the resected patients with the survival of non-resected patients listed in the New Jersey and Pennsylvania tumore registries. 4) To evaluate screening tests for PHC other than AFP; specifically, serum ferritin levels, monoclonal antibodies to PHC ferritin an glycosylated/monoglycosylated ferritin. To carry out this program, a Liver Cancer Prevention Center (LCPC) has been established at Fox Chase Cancer Center (FCCC). The HBV carriers will be identified through the Philadelphia Health Department clinics, church screenings, private physician referrals and testing at the LCPC. Carriers will be monitored at six-month intervals at the LCPC for AFP elevation. Persons with characteristic AFP elevations will undergo scanning and other diagnostic procedures for PHC. All treatment and follow-up will be carried out at the FCCC.
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