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Gastroenterologists can enhance hepatitis C screening by testing individuals referred for colorectal cancer screening

Dear Editors, We read with interest the article by Younossi et al. [1] ‘Knowledge About Infection is the Only Predictor of Treatment in Patients with Chronic Hepatitis C’ that supported the expansion of hepatitis C screening and improving individuals understanding of their disease states. We are in agreement that improving knowledge about the prevalence of hepatitis C infection and identifying infected individuals is the best way to increase the frequency of treatment. In 2012, the Centers for Disease Control and Prevention recommended that hepatitis C screening be carried out by birth cohort (1945–1965), rather than solely by identified risk factors [2]. Efforts to increase screening will enable affected individuals to undergo increasingly effective therapy. Hepatitis C eradication will lead to improved healthcare outcomes and a significant decrease in national healthcare expenditures [3, 4]. We conducted a study to evaluate internists’ adherence to new hepatitis C screening guidelines at an urban, university medical centre. A retrospective medical record review of 455 consecutive patients born between 1945 and 1965 who were seen for preventive care and referred to gastroenterologists for colorectal cancer screening was performed. There were 174 men and 241 women. Racial distribution of patients was as follows: 121 Caucasian, 253 African American, 28 Hispanic, 14 Asian, 4 Middle Eastern and 25 with undocumented ethnicities. 102 of 455 (22.4%) had hepatitis C serology performed, with only 51 tested because of their birth year. Notably, white individuals were tested less frequently than non-white individuals, 12.4% compared with 22.6% (p = 0.02). There was no significant difference in the rate of hepatitis C screening based on gender (p = 0.3567) or age within the cohort (p = 0.14). The revision of hepatitis C screening guidelines is a key to improving the identification of infected individuals. The improved efficacy of treatment warrants enhanced screening. However, our study demonstrated that patients in the birth cohort recommended for hepatitis C screening are infrequently tested. In addition, white patients were less frequently tested than others. While this study is limited based upon its single institution design, it is possible that the results are a reflection of lack of physician or patient awareness of the new screening guidelines. Increased recognition of the need for testing will increase frequency of treatment and ultimately healthcare outcomes. Gastroenterologists have the potential to increase the identification of individuals with hepatitis C by offering serologic testing to those patients who are referred for colorectal cancer screening.