Opportunities to address gaps in early detection and improve outcomes of liver cancer
Open accessAbstract
Death rates from primary liver cancer (hepatocellular carcinoma [HCC]) have continued to rise in the United States over the recent decades despite the availability of an increasing range of treatment modalities, including new systemic therapies. Prognosis is strongly associated with tumor stage at diagnosis; however, most cases of HCC are diagnosed beyond an early stage. This lack of early detection has contributed to low survival rates. Professional society guidelines recommend semiannual ultrasound-based HCC screening for at-risk populations, yet HCC surveillance continues to be underused in clinical practice. On April 28, 2022, the Hepatitis B Foundation convened a workshop to discuss the most pressing challenges and barriers to early HCC detection and the need to better leverage existing and emerging tools and technologies that could improve HCC screening and early detection. In this commentary, we summarize technical, patient-level, provider-level, and system-level challenges and opportunities to improve processes and outcomes across the HCC screening continuum. We highlight promising approaches to HCC risk stratification and screening, including new biomarkers, advanced imaging incorporating artificial intelligence, and algorithms for risk stratification. Workshop participants emphasized that action to improve early detection and reduce HCC mortality is urgently needed, noting concern that many of the challenges we face today are the same or similar to those faced a decade ago and that HCC mortality rates have not meaningfully improved. Increasing the uptake of HCC screening was identified as a short-term priority while developing and validating better screening tests and risk-appropriate surveillance strategies.
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Improved screening and diagnostic techniques allow for earlier and more accurate detection, while changes in disease registry systems may enhance the ability to capture current epidemiological trends, potentially leading to higher reported prevalence rates.
“Improved screening and diagnostic techniques allow for earlier and more accurate detection, while changes in disease registry systems may enhance the ability to capture current epidemiological trends, potentially leading to higher reported prevalence rates [27,28].”
From Global epidemiology of alcohol-related liver disease, liver cancer, and alcohol use disorder, 2000–2021 (2025) · cites this paper as [27]
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Hepatitis-Associated Liver Cancer: Gaps and Opportunities to Improve Care: Table 1.
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Self-citation
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- Authors
- McMahon, B., Cohen, C., Brown Jr, R. S., El-Serag, H., Ioannou, G. N., Lok, A. S., Roberts, L. R., Singal, A. G., & Block, T.
- Affiliations
- Alaska Native Tribal Health Consortium (US)
- Hepatitis B Foundation (US)
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine , New York, NY, USA
- Department of Medicine, Baylor College of Medicine , Houston, TX, USA
- VA Puget Sound Health Care System (US)
- University of Michigan (US)
- Mayo Clinic (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Cohen, Chari
- ORCID
- Venue
- JNCI Cancer Spectrum
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-05-02
- Volume
- 7
- Issue
- 3
- ISSN
- 2515-5091 (ISSN-L)
- PMC
- PMC10212536
- OpenAlex
- W4372330520
- Cited by
- 44
- References
- 102
- Citations by year
- 2026: 8 · 2025: 18 · 2024: 18
- FWCI
- 7.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- JNCI Cancer Spectrum (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Hepatitis B Foundation
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- hepatocellular carcinoma, liver cancer, early detection, cancer screening, HCC surveillance, screening uptake, risk stratification, biomarkers, artificial intelligence in imaging, risk prediction algorithm, HCC mortality, hepatitis B, barriers to screening
- MeSH terms
- Artificial Intelligence, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Prognosis, Risk Factors
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