Tuesday, October 29, 2013

Doctors Push to Screen Baby Boomers for Hepatitis C

Millions of healthy baby boomers in USA may get a surprising request at future doctor visits: Get tested for hepatitis C, the potentially fatal liver virus commonly thought to affect mostly intravenous drug users.

A small minority of boomers are thought to suffer from the disease. But momentum is building to have more than 60 million screened because of easier testing methods and less harmful and more effective treatment.

Called a "silent epidemic," hepatitis C affects roughly 3.2 million people in the U.S., though at least half of those infected don't know it, health officials say. Often, symptoms don't appear until dangerous complications like cirrhosis or cancer have already occurred. The Centers for Disease Control and Prevention attributes 16,600 deaths to hepatitis C in 2010, the most recent year for which data is available. Many could have been avoided had patients been diagnosed and treated earlier.

Boomers—people born in the U.S. between 1945 and 1965—are more likely to suffer from hepatitis C than others. The reasons: high rates of experimental drug use in the 1960s and 1970s, and lack of oversight given to the blood supply used in all transfusions before 1992, officials say. Boomers, now in their late 40s to late 60s, may not realize they have been exposed to potentially infected blood. Many people may not know if they had a blood transfusion even if they know they had a car accident and went to the hospital decades ago.

The U.S. Preventive Services Task Force, an influential medical guidelines body, recommended in June that people born between 1945 and 1965 be offered screenings. Under the Affordable Care Act, the recommendation means that most private health insurers must now pay the full costs of screening at no out-of-pocket cost to patients. State Medicaid programs that cover the cost of screenings recommended by the task force receive extra funding under the ACA.

The price of initial hepatitis C testing ranges up to $200 and additional tests may be required.

New York last week became the first state to enact a law requiring that boomers be offered screening when they see a doctor or enter the hospital. If a person test negative, he/she can have peace of mind and if found positive then he/she can get the care they need.

Some physicians who plan to follow the task force's recommendation said they worry it could become burdensome. Doctor visits tend to be short, and older patients can have a raft of health risks that require attention. Ensuring that optional screening is offered to patients will be a challenge, health officials acknowledge. Electronic medical records may help.

With increased screening, however, comes the risk that many people will receive expensive, unneeded treatment or suffer undue pain through testing procedures. The majority of people with hepatitis C will never suffer liver damage and ultimately die of other causes. Until recently, that kept officials from recommending screening to people without known risk factors, such as sharing needles during drug use or having received blood transfusions or organ transplants before 1992. It's possible to contract the disease through sex, though uncommon.

Advances in treatment and minimally invasive diagnostics have started to change the risk-benefit calculation. In the past, biopsies were common for people who tested positive for the virus. The procedure can cause severe pain, bleeding or infection in 1% of patients and, more rarely, death. Liver biopsies have become less common with the development of blood tests capable of detecting liver scarring.


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