Doctors Predict Success of New Test

Doctors at a Harvard-affiliated hospital have discovered a ground-breaking test which they say will facilitate earlier and more accurate detection of one of the most lethal cancer forms.

The new test for primary liver cell cancer, developed by doctors at the Massachusetts General Hospital and the Institute Gustave-Roussy near Paris, is expected to be four to 10 times as sensitive as current tests for a protein that indicates the presence of the disease.

Primary liver cell cancer is nearly 100 percent fatal because tumors in the liver are almost never discovered early enough for removal, and this particular type of cancer has proven "very resistant to chemotherapy," said Dr. Jack R. Wands, an associate professor of medicine at the Medical School and co-author of the discovery.

Landmark

If tumors are discovered accidentally during examination for another illness, doctors can remove them, and--in more than half such cases--patients can survive for five or more years.

But most diagnoses come too late, leaving the average patient with a life expectancy of three to six months.

Wands and his French colleague, Dr. Dominique Bellet, announced Tuesday that they had developed the new test, which examines the blood levels of alphafetoprotein (AFP), a substance produced in the liver of fetuses but which usually disappears after birth.

Its reappearance is often an indicator of primary liver cell or testicular cancer.

Cancer in the liver is most often associated with exposure to hepatitis-B virus, which is now rare in the United States, but carried by an estimated 250-300 million people worldwide. It is most common in the Far East and sub-Saharan Africa.

Wands called the new test "the first major advance for what is perceived as the most lethal cancer in the world."

He described its three greatest advantages as its sensitivity to AFP, its specificity, and the fact that it is very simple and inexpensive to perform.

Requiring only an hour to complete, the test can be done in the most basic laboratory and will cost only about $1 or $2. Wands said Pending IDA approval, it could be available within a few months to a year, he added.

Wands and Bellet tested the new detective method on more than 3,000 subjects, some of them carriers of hepatitis, B. others sufferers of cirrhosis or other malignant tumors of the liver. They found that only those with primary liver cell cancer showed high levels of AFP.

But one gastroenterologist at Harvard-affiliated Brigham and Women's Hospital said yesterday that "we have to have a healthy skepticism" about the test's effectiveness.

He said there was a danger that the test would defect high AFP levels in the blood of patients who did not have primary liver cell cancer, but instead had some other disease of the liver.

"A lot of people could get scared they have cancer, just because of a little AFP," he said, adding that this misdiagnosis is more likely in the United States, where only, 1 percent of the population carries hepatitis-B and even fewer get liver cancer.

But the test's authors claim in their article, published in the Journal of The National Academey of Sciences, that the test is so specific that it will detect only cancer-caused AFP elevation.

Wands said Wednesday that he was not sure how often the disease could be detected early enough to save lives, but added that for high risk subjects, he and Bellet would recommend the test twice yearly.

The team said they will spend the next several months evaluating the new detector in Taiwan and also in the United States. Wands said that the test will probably be used initially only for high-risk patients, including hepatitis B. carriers