Improving hepatocellular carcinoma screening: applying lessons from colorectal cancer screening

Hepatocellular carcinoma (HCC) screening is a complex process, with failure at any step in the process contributing to a gap between its efficacy and effectiveness. Important lessons can be learned from colorectal cancer (CRC) screening studies to improve the HCC screening process in clinical practice. Lack of provider recommendations is a barrier for both CRC and HCC screening; however, under-recognition of at-risk individuals appears to be unique to HCC. Future HCC screening interventions should help providers identify at-risk patients as well as promote ordering of HCC screening among those with cirrhosis. Patient adherence, a well-recognized barrier to CRC screening, does not appear to be a major issue in HCC screening. Poor patient adherence may become an important factor in the future when upstream provider-level factors are addressed. Other steps in the screening process, including radiology capacity and timely follow-up, have been demonstrated as barriers for CRC screening but have yet to be assessed for HCC screening. Overall, many lessons learned from challenges to CRC screening can be applied to rapidly optimize HCC screening delivery.