Screening for hepatocellular carcinoma. Review and perspective

Area of Science:

• Hepatology
• Oncology
• Gastroenterology

Background:

• Hepatocellular carcinoma (HCC) diagnosis and treatment vary globally.
• Viral hepatitis is a primary cause of HCC in Asia, while alcoholic cirrhosis is more prevalent in the US.
• Current screening methods (serum alpha-fetoprotein and ultrasonography) are effective in Asia but their applicability in the US is uncertain.

Purpose of the Study:

• To evaluate the effectiveness of current HCC screening methods in the US population.
• To determine if surgical resection of early-stage HCC improves survival in patients with underlying cirrhosis.
• To highlight the importance of preventing HCC risk factors worldwide.

Main Methods:

• Review of existing data on HCC screening and treatment outcomes.
• Comparison of HCC etiology and risk factors between Asian and American populations.
• Identification of the need for prospective screening trials in the US.

Main Results:

• Serum alpha-fetoprotein assay and abdominal ultrasonography are feasible screening tests for HCC in Asia.
• Data from Asia may not be directly applicable to the US due to differing risk factors (alcoholic cirrhosis).
• The survival benefit of resecting "curable" HCC lesions in patients with cirrhosis remains unclear.

Conclusions:

• Further screening trials are needed to establish effective HCC detection methods for at-risk populations in the US.
• Preventing HCC risk factors, particularly Hepatitis B virus infection, is a critical global health priority.
• Early diagnosis of hepatocellular carcinoma remains the most promising strategy for curative treatment.