Cancer risk in severe alpha-1 antitrypsin deficiency: the importance of early identification

We are thankful for the shown interest and important input from doctors Fromme and Strnad [1]. That the individuals suffering from severe alpha-1-antitrypsin deficiency (AATD) have an increased risk of developing liver diseases including hepatic cancer is previously known [2, 3]. Our main aim in the recently published article [4] was, in addition to investigate the risk for hepatic cancer, to evaluate the risk for developing other types of cancers (non-hepatic cancers). We are grateful for the up-to-date summary on the knowledge of hepatocellular carcinoma provided by Fromme and Strnad. We strongly agree on the need for a regular surveillance in individuals with severe AATD regarding development of hepatocellular cancer. In Sweden, the individuals with severe AATD are regularly (every 2 years) followed-up with liver enzymes, but not with elastography or ultrasound of the liver [5]. Footnotes This manuscript has recently been accepted for publication in the European Respiratory Journal . It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article. Conflict of Interest: Anne Lindberg reports lecture honoraria from Boehringer Ingelheim, Novartis; personal fees for advisory board participation with AstraZeneca, GlaxoSmithKline, Novartis, Boehringer Ingelheim; outside the submitted work. All other authors have nothing to disclose.