In a recent editorial in American Family Physician, I explained why I continue to feel that family physicians should not be required to institute routine birth cohort screening for hepatitis C. Please read the whole piece if you can, but if you don't have a personal or institutional subscription to the journal, here is the bottom line:
In summary, recent innovations in identification and management of patients with HCV infection have left family physicians facing important unanswered questions. Is it worthwhile to modify practice workflows to prioritize screening for HCV in middle-aged and older adults without any known risk factors, who are more likely to be at risk of cardiovascular disease and cancer than HCV infection? In persons who test positive for HCV, who should be treated or referred for treatment, knowing that many will not benefit?
Given current scientific uncertainties, limited resources, and evolving guidelines, a reasonable middle ground would be for family physicians to collaborate with subspecialty colleagues and focus HCV testing and therapy on patients who are most likely to have long-term complications from the infection, such as those with human immunodeficiency virus infection or type 2 diabetes mellitus, rather than instituting more broad screening and treating everyone who tests positive.