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Publications

Journal Article Review Epublish 1 citation

PubMed: 42819713 DOI: 10.1016/j.lanepe.2026.101852

Hepatocellular carcinoma surveillance in Europe: challenges and lessons from global practice.

Lancet Reg Health Eur 70:101852

Authors: Maria Qurashi, Maria Buti, Grace Lai-Hung Wong, Huma Qureshi, Masatoshi Kudo, Tawesak Tanwandee, Chien-Jen Chen, Ashraf Omar Abdelaziz, Mohamed AbdAllah, Jessica Howell, Vanessa Hebditch, Amit G Singal, Peter Jepsen, Rohini Sharma

Affiliations

  • Department of Surgery and Cancer, Imperial College London, United Kingdom.
  • Liver Unit Hospital Universitario Valle Hebron, Barcelona, Spain.
  • Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
  • Doctor's Plaza, Clifton, Karachi, Pakistan.
  • Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan.
  • Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
  • Genomics Research Center, Academia Sinica, Taipei, Taiwan.
  • Department of Endemic Medicine and Hepatogastroenterology, Cairo University, Cairo, Egypt.
  • Medical Research Division, National Research Centre, Cairo, Egypt.
  • Burnet Institute, Melbourne, Australia.
  • Department of Gastroenterology, St Vincent's Hospital Melbourne, and Department of Medicine, University of Melbourne, Australia.
  • British Liver Trust, United Kingdom.
  • Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
  • Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
  • Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
  • School of Medicine, University of Nottingham, Nottingham, England, United Kingdom.

Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide and a public health concern, with 75% of cases considered preventable. Biannual liver ultrasound, with or without serum alpha-fetoprotein, is recommended as surveillance for patients at high risk of HCC. While the rationale for surveillance is strong and it continues to be recommended by all professional societies, there is ongoing debate about the strength and relevance of the evidence supporting surveillance for all populations with cirrhosis. European surveillance uptake is suboptimal, with high rates of late-stage diagnosis and subsequent poor prognosis. In this paper, we provide an overview of surveillance focusing on Europe and draw lessons from across the world. We discuss lessons learnt from the implementation of national and coordinated surveillance programmes in Asian countries and the global challenges resulting from the changing epidemiology of chronic liver disease, particularly the rise of MASLD. We consider the patient perspective, including stigma and inequalities in access and delivery. We explore emerging approaches to surveillance, including biomarkers, abbreviated MRI and risk-stratification, which may improve early diagnosis. Finally, we address the lack of funding and political willpower arising from an insufficient evidence base.

MeSH

Carcinoma, Hepatocellular, Liver, Diagnosis