Greatest Generation

CDC Recommends Hepatitis C Testing for All Boomers
by Larry Buhl

For years CDC guidelines called for hepatitis C (HCV) testing when someone has known risk factors, including blood transfusions or organ transplants before 1992 (when effective screening became common), or any IV drug use.

Now, the CDC has determined that just being born a baby boomer is enough risk for hep C, and recommends that everyone born between 1945 and 1965 should get a blood test at least once to check for the hepatitis C antibody. If a person tests positive (some people may have cleared the virus but still carry the antibody), a further test would be made to confirm that the person carries HCV. Those testing positive for the virus would then be recommended for treatment at the discretion of their doctors.

Dr. Raymond S. Koff, clinical professor of medicine at the University of Connecticut School of Medicine and vice chair for Hepatitis Foundation International, hails the announcement and says it will be a lifesaver for many.

“The majority of people carrying the hepatitis C virus don’t know they’re infected because the disease is silent until it advances and there are often no symptoms until late in its progression,” he tells A&U.

Dr. Koff adds that the CDC chose the baby boomer cohort because the group has the highest prevalence of HCV infection in the U.S. (estimated at three percent) versus 1.3 percent nationwide for all age groups.

Health advocates say that people are often embarrassed to admit to a risk factor, or don’t remember one because it happened so long ago. “Many baby boomers may not even remember the behaviors that put them at risk, and therefore singling out an entire cohort for testing would identify many more hidden infections before they develop into life-threatening liver disease,” said John W. Ward, head of the CDC’s division of viral hepatitis, in a conference call.

Just one test of all the members of that generation may identify 800,000 people with hepatitis C, preventing liver cancer and perhaps saving 120,000 lives, the Center says.

In addition to saving lives, there is also the cost factor. Three research papers were published this year in the Annals of Internal Medicine that showed the cost-effectiveness of baby boomer testing and HCV treatment.

“Identifying the virus in as many people as possible early in the disease’s progression will save money because there will be less need for liver transplants and caring for people who would have developed liver disease,” Dr. Koff says.

With a call for testing such a huge group, there are risks and downsides, Koff says. “It is a very arbitrary cutoff in age,” he tells A&U. “What if you’re born in 1944 or 1966? Will those people decide they shouldn’t be tested? Also the number of infected boomers is probably quite large, so if you do identify all of these people, will there be enough facilities capable of treating them?”

There is also the issue of outreach. Right now the CDC is waiting for public comment before doing any outreach and education. The most likely scenario is to publish articles in medical journals seen by those in the medical community and let the doctors start the discussion with their baby boomer patients.

“The reality is not everyone will rush out and get tested right away, and you wouldn’t want that because it would overwhelm the system, Dr. Koff says, adding that probably no more than twenty percent of boomers would voluntarily be tested in the first year.

The CDC still recommends regular testing for those who meet classic risk factors. Those who are diagnosed with HCV infection should be linked to care and treatment.

A government call for such broad testing is unusual but not unprecedented. For years the CDC has been advising that all Americans be tested for HIV.
Liver cancer is the fastest-growing cause of cancer deaths in the U.S. and hepatitis C is the leading cause of liver cancer. A blood test is the only way to identify hepatitis C infections, according to the CDC.

The Center offers an on-line risk assessment to help people determine their risk factors. Log on to

Larry Buhl is a freelance journalist and screenwriter living in Los Angeles.

July 2012