Screening for Hepatocellular Carcinoma in Adults at Increased Risk

Landsteiner A, Ullman K, Langsetmo L, Zerzan N, Kalinowski C, Haglund J, Wilt TJ. Screening for Hepatocellular Carcinoma in Adults at Increased Risk. VA Evidence-based Synthesis Program Reports. Washington (DC): Department of Veterans Affairs (US); 2023 Nov 1.

Screening for HCC among adults at increased risk (especially those with cirrhosis) has been recommended by several specialty societies (eg, American Association for the Study of Liver Diseases [AASLD], European Association for the Study of the Liver [EASL]) (typically through abdominal ultrasound imaging with AFP every 6 months) and is considered a quality metric for practice performance by AASLD. However, the National Cancer Institute’s Physician Data Query concluded that based on fair evidence, screening of persons at elevated risk does not result in a decrease in mortality from HCC and would result in rare but serious side effects. The United States Preventive Services Task Force and other USA medical societies have not issued HCC screening guidelines. Questions surrounding screening include whether to conduct screening, the appropriate imaging technique if conducting screening (ultrasound, magnetic resonance imaging [MRI], computed tomography [CT]), use of AFP, screening intervals (eg, 3, 6, or 12 months), populations defined as increased or “at risk” and thus potential screening candidates, and when to discontinue screening.