American Board of Internal Medicine (ABIM) Certification Practice Exam

In which patient group should HCC surveillance be indicated due to chronic HBV infection?

1. All patients older than 30 years

2. Patients with first-degree relatives who had liver cancer

3. Men older than 40 years and women older than 50 years in Asian populations

4. Individuals with diabetes over age 60

The correct answer is: Men older than 40 years and women older than 50 years in Asian populations

The recommendation for hepatocellular carcinoma (HCC) surveillance in patients with chronic hepatitis B virus (HBV) infection is particularly focused on demographic and risk factors associated with the disease. In this context, men older than 40 years and women older than 50 years in Asian populations represent a group at significantly increased risk for developing HCC due to their demographic background and higher prevalence rates of HBV-related liver cancer in these populations. These age thresholds have been established based on studies showing that the risk of HCC rises notably after these ages, implicating both age and sex as important factors in the risk stratification for surveillance. The necessity for surveillance in this specific demographic is driven by data indicating that early detection can significantly affect outcomes for patients with HCC. Routine screening in this high-risk group is thus crucial as it aims to identify liver cancer at an earlier, more treatable stage. While families with a history of liver cancer and individuals with diabetes are certainly at risk for various liver diseases, the specific age and demographic criteria outlined for men and women of Asian descent provide a more targeted approach based on robust epidemiological data linking HBV infection, age, gender, and ethnicity to HCC development.