Are you a baby boomer? Have you been tested for hepatitis C virus (HCV)? Do you know why you should be tested for hepatitis C? Do you even know what hepatitis C is?
According to research published today by my colleagues from the American Cancer Society in the American Journal of Preventive Medicine, the odds are overwhelming that if you are in the boomer generation you have not been tested for the virus, and that has me wondering why that is the case. Could it be that we don’t know about hepatitis C? Could it be that our health professionals aren’t recommending testing? Could it be that the costs of treatment may be seen as a barrier to care?
Why is this important? Because if you do have hepatitis C you are at risk of dying from liver cancer and other diseases. The kicker: the deadly results of hepatitis C can be prevented with an effective, albeit expensive treatment. Deaths from liver cancer in the United States are increasing more rapidly than any other type of cancer, according to a recent report. And even when localized at diagnosis, liver cancer is most often fatal.
It doesn’t necessarily have to be this way. Hepatitis C infection can be prevented, and even when that is unsuccessful can be eliminated. And when it is, the risk of liver cancer and other fatal diseases such as cirrhosis decline considerably.
In 2013, the United States Preventive Services Task Force (USPSTF) recommended screening for hepatitis C in individuals at high risk and/or those born between 1945 and 1965 (you can find the information on “high risk” at the USPSTF website here).
For this analysis, the researchers limited their study to those born from 1945-65 and compared the percentages of people in this age group who had ever been tested for HCV in 2013—the year the testing recommendation was made—and 2015.
The results were remarkably underwhelming: in 2013, 12.3% of the baby boomers had ever had an HCV test, while in 2015 13.8% reported they had ever been tested—an increase of 1.5%. That translated into 10.5 million of 76.2 million eligible people in 2015 having received the recommended HCV test.
What was interesting is that in this study—unlike what we usually see—people on Medicaid, Medicare and Medicaid (so called “dual eligibles”) and military insurance all had increased rates of testing compared with people who had private insurance. On the other hand, those with a high school diploma or less education had a woefully low rate of testing compared to college graduates (about 40% less often). This may be explained in part by the fact that the Veterans Administration and some “safety net” hospitals and clinics may have put structured screening programs in place, while private practices have been slower to make such organized efforts.
Since HCV testing is recommended by the USPSTF, it should be covered under most health insurance plans. Medicare covers the test once, if ordered by a primary care physician or health professional. So cost for the HCV test itself should not be a barrier. And although the treatment of HCV is not inexpensive, it is short in duration, well tolerated, and when taken properly has a high rate of cure for HCV infections.
So if all of that is true—and it is—then we need to ask why my colleagues’ research finds so few boomers are getting tested for HCV?
Maybe it has to do with the television ad campaigns promoting the drug used to treat hepatitis C infection. Part of me wonders if those advertisements can sometimes have the opposite effect of what is intended, reinforcing a negative perception of treatment as a result of ongoing discussions about cost and access.
Yes, treatment for hepatitis C is available and effective. And, yes, it is very expensive. Insurers have responded to that cost by setting in place a number of requirements that must be met for coverage to be available. And co-pays and deductibles can possibly put treatment out of reach for some, notwithstanding efforts by pharma companies to provide patient assistance programs. For some, such as those insured under Medicaid (also here), treatment can be delayed in some states because of fiscal concerns about costs and budget impacts. And for those in jail—a population at especially high risk of HCV infection and where state and local jurisdictions have to pick up the tab–there may be other barriers in place.
Whatever the reason, the reality is we are not accomplishing a goal that is within our reach, namely the prevention of a lethal cancer.
From a cancer control perspective we now have a path to detect and treat HCV infection which could substantially reduce the risk of many cases of liver cancer. The American Cancer Society estimates that in 2017 there will be almost 41,000 cases of liver cancer diagnosed in the United States and 29,000 deaths. Although not all of these deaths can be prevented, the chances are high that many could be avoided through effective prevention, detection and treatment strategies for hepatitis B and C.
Today’s research report shows even with recommendations from respected medical organizations, access to testing, and treatments that work we are not implementing those cancer prevention strategies for those who would benefit. Simply stated, we know what to do however for some uncertain reasons we just don’t do it.
When it comes to saving lives—and avoiding the heartache of cancer–it’s about time we paid attention and got the job done.