Liver cancer surveillance rests on observational evidence; risk-based targeting may help

An expert opinion in the Journal of Hepatology, published in July, reviews the evidence behind six-monthly liver cancer surveillance in people with cirrhosis or chronic hepatitis B.

The authors note that the rationale is strong and observational studies support it, but no randomised trial has shown a survival benefit, which is why national screening committees have been reluctant to endorse it. Surveillance is often applied to groups where cancer is uncommon, and with imperfect tests most positive results are false. Low incidence, limited test sensitivity and death from other causes mean many patients gain little. They argue for risk-based surveillance using prediction models, which are already in use for chronic hepatitis B.

Nothing here argues for abandoning surveillance in high-risk patients, and current guidelines are unchanged. It is a case for spending the effort where risk is highest: people with cirrhosis of any cause and those with hepatitis B who meet guideline criteria, rather than everyone with fatty liver.

• Continue guideline-based ultrasound surveillance for patients with cirrhosis and high-risk hepatitis B.
• Use a validated risk score in chronic hepatitis B to judge who most needs surveillance.
• Explain to patients that a positive surveillance scan is often a false alarm and will need confirmation.
• Consider competing health problems before enrolling frail patients in long-term surveillance.

Why it matters

It reframes surveillance as something to target by risk rather than apply to everyone with liver disease.

Don't overread it

This is expert opinion; it does not change current surveillance guidelines.

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