- Design
- International Delphi consensus
- Population
- 35 multidisciplinary experts from six continents
- Primary outcome
- Agreement on 17 statements on CRC risk in MASLD
- Effect
- Consensus reached on all 17 statements
A Delphi consensus in Gut (September 2026) brought together 35 experts from six continents to rate 17 statements on colorectal cancer in metabolic dysfunction-associated steatotic liver disease (MASLD). Consensus was reached on all 17.
The panel agreed that MASLD is associated with increased colorectal cancer risk, that greater metabolic burden raises it further, and that more severe MASLD is associated with worse cancer outcomes. They highlighted weight loss, earlier screening, bariatric surgery and GLP-1 receptor agonists as potential risk-reduction strategies, and called for earlier, risk-adapted screening.
Consensus is not evidence of benefit, and no trial has yet shown that earlier screening in MASLD reduces cancer deaths. The recommendation is a direction of travel rather than a protocol.
- Make sure patients with MASLD are up to date with colorectal cancer screening
- Investigate lower GI symptoms promptly in patients with MASLD and metabolic risk factors
- Treat MASLD as a marker of wider metabolic risk, including cancer
- Weight loss helps both liver disease and, plausibly, cancer risk
Why it matters
It links a very common liver diagnosis to a cancer that screening can catch early.
Don't overread it
This is expert consensus; it does not show that earlier screening in MASLD improves outcomes.
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