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Advocates Slam Task Force (USPSTF) for Not Backing Hepatitis C Tests for Baby Boomers
  By Jane Norman, CQ HealthBeat Associate Editor
November 27, 2012

Advocates for wider screening for hepatitis C criticized a government panel Tuesday for not issuing a stronger recommendation that all baby boomers get a one-time test to make sure they aren't infected with the deadly virus.

It constituted yet another flap involving the U.S. Preventive Services Task Force, an advisory government panel that's been lambasted in the past for recommending less mammogram testing for women under 50 and other controversial recommendations (See related story CQ Weekly, Jan. 30, 2102).

Hepatitis C leads to advanced liver disease and liver cancer yet medications are available to cure it in many people, especially when found early, advocates said. People born between 1945 and 1965 make up 75 percent of the nation's 3 million to 4 million cases of hepatitis C. The task force didn't recommend routine screening for members of that generation.

The virus, passed through blood, generally is contracted through intravenous drug use, causes few symptoms and might not be detected for years. People also may have contracted it in blood transfusions prior to 1992. About 3 percent to 4 percent of baby boomers are thought to have hepatitis C, a rate five times higher than that of other adults, experts said. Hepatitis B, a related virus, is spread through blood or body fluids, is preventable with a vaccine and is less likely to become chronic among adults.

"We need to know who's infected and how they are going to be treated," John Bartlett, a professor of medicine in the division of infectious diseases at the Johns Hopkins School of Medicine, said during a news conference at a national summit on AIDS and viral hepatitis.

The National Viral Hepatitis Roundtable, a coalition of groups that battle viral hepatitis, said in a statement that the task force recommendation doesn't match up with Centers for Disease Control and Prevention guidelines that everyone born between 1945 and 1965 be tested. "We'll miss a tremendous opportunity to save lives," said Martha Saly, executive director of the group.

The task force on Monday issued a "B" grade draft recommendation that all people deemed to be at high risk of hepatitis C be tested (See related story CQ HealthBeat, Nov. 26, 2012). That means their screening would be covered at no cost as a preventive service under the health care law (PL 111-148, PL 111-152).

The task force recommended a "C" grade for testing baby boomers, which means screening was found to be of small net benefit. Task force members said in their report that doctors "may consider" screening for the 1945-1965 age group.

John Ward, director of the CDC Division of Viral Hepatitis, said at the summit meeting that the CDC regards viral hepatitis as an "urgent public health crisis." The agency went through an extensive review of the scientific evidence on the disease and its impact on people's quality of life before issuing its recommendation for the testing of baby boomers, he said.

"We are really in the midst of an epidemic of viral hepatitis related disease and mortality," Ward said.

Bartlett said the task force also delayed on recommending widespread testing for HIV for five years, issuing that recommendation earlier this month (See related story CQ HealthBeat, Nov. 19, 2012). "What did we learn in that five years? Nothing," he said, speaking during the 2012 National Summit on HIV and Viral Hepatitis Diagnosis, Prevention and Access to Care.

The question is how many infections were transmitted during that period to people who "now will be slaves to HIV medicine the rest of their lives at tremendous cost," Bartlett said. "How long are we going to have to wait for hepatitis C to catch up?"

The next two years will bring more drugs that will cure hepatitis C and are mostly oral to be taken by patients, he said. "They become uninfected and can't transmit," he said. "You can put out a disease, which is an extraordinary value."

In issuing the "C" grade for adults without symptoms, the task force said that concerns over screening in adults without symptoms include anxiety, labeling, an "impact on relationships," as well as the harm that might come through liver biopsies and medications.

Saly of the Viral Hepatitis Roundtable said health care providers look to the task force for guidance on what tests to conduct ,and the "C" rating will mean many people won't get tested. The CDC has estimated 400,000 people currently infected with hepatitis C will develop liver cancer and 1 million will die of related complications in the decades to come.

A spokeswoman for the task force said members were not available Tuesday for comment.

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