Which is better – Liver Cancer Screening with Abbreviated Magnetic Resonance Imaging (aMRI) or ultrasound for detecting Liver Cancer? A new Trial Study conducted by the Department of Veterans Affairs (VA), starting in 2023, may provide a valuable answer to that debated question.
The results of a trial involving 4,700 veterans with cirrhosis may make the difference for a veteran’s risk of death. Cirrhosis is liver scarring caused by several different conditions.
The planned 2023 Study is known as PREMIUM –PREventing liver cancer Mortality through Imaging with Ultrasound vs MRI. It will be the largest clinical trial in history related to liver cancer screening.
The ultrasound test is the current standard of care in reducing liver cancer deaths in veterans. However, the quality of the ultrasound testing can vary significantly depending on the person doing the procedure and the body type of the veteran.
The MRI is known as the “Gold Standard” for detecting liver cancer once a mass is detected on the ultrasound test. However, an abbreviated MRI (aMRI) is a much shorter procedure than the standard MRI. The aMRI has shown promise in detecting liver cancer at early stages.
The standard MRI is time-consuming (30-45 minutes of scanner time), which reduces its’ cost-effectiveness as a screening modality in patients with cirrhosis.
The aMRI method has a similarly high sensitivity and specificity as a standard MRI screening and more importantly it can be completed in as much shorter time than fifteen (15) minutes.
Recent statistics have indicated that cirrhosis is the leading factor for Hepatocellular Carcinoma (HCC), which is the sixth (6th) leading cause of cancer-related deaths in the United States.
While the deaths related to lung, breast, prostate and colorectal cancers are declining, HCC is the only malignancy with rising mortality in both women and men.
Forty-seven (47) VA Medical Centers (VAMC) will participate in the PREMIUM Trial Study and they will enroll 100 veterans (ages 18 to 75 years old), at each VAMC. After the enrollment phase is completed, the trial study will begin in July of 2023 and will follow these 4,700 veterans over an eight-year period.
PREMIUM will be the first clinical trial study to directly compare the two (2) types of liver cancer screening methods. It should be noted that the VA is the largest health care provider in the United States for patients with cirrhosis, the leading factor for liver cancer.
“The VA has a high prevalence of patients with advanced liver disease who could benefit from screening for liver cancer,” said Dr. Carolyn Clancy, the Assistant Under secretary of Health for Discovery, Education and Affiliate Networks.
“This Study has the potential to change clinical practice for tens of thousands of veterans and non-veterans alike,” continued Dr. Clancy. “It could answer key questions about liver cancer screening that have been debated for more than three (3) decades.”
It should be noted that the PREMIUM Study is one of several research studies that will be conducted under the auspices of the 21st Century Cures Act, which was passed by Congress in 2016.
Congress allocated $1.8 billion in funds to provide seven (7) years of funding for cancer research in such areas as new clinical trial networks to drive drug discovery, studies on cancer disparities and innovative projects to reduce the death rate of cancer.
The goal of the 21st Century Cures Act was to reduce the death rate from cancer related illnesses by fifty (50%) percent over the next twenty-five (25) years.
My Opinion: Research conducted in August of 2021 has indicated that nearly half of patients who receive care at VAMCs have risk factors for liver disease. Yet, according to the study, fewer than ten (10%) percent of disabled veterans with these risk factors receive a diagnosis of cirrhosis.
The VA researchers hope to use this research/data to encourage population-level screening for advanced liver disease. This effort may ultimately enable earlier intervention.
If liver cancer (or cirrhosis) is detected during the earlier stages of the disease; then there is a better chance for more curative treatments. This may also result in a reduction in the number of liver-cancer deaths among our disabled veterans.
The PREMIUM Trial Study may certainly resolve the debate if aMRI or ultrasound is a better option for liver cancer screening. The VA should be commended for undertaking this study!
BioSketch: John Plahovinsak is a retired 32-year Army veteran who served from 1967 to 1999. He is the Disabled American Veterans (DAV) Department of Ohio Hospital Chairman. He can be contacted at plahovinsak@msn.com.