Opportunities to address gaps in early detection and improve outcomes of liver cancer

Author:

McMahon Brian1,Cohen Chari2ORCID,Brown Jr Robert S3,El-Serag Hashem4,Ioannou George N5,Lok Anna S6,Roberts Lewis R7,Singal Amit G8,Block Timothy9

Affiliation:

1. Liver Disease and Hepatitis Program, Alaska Native Tribal Health Consortium , Anchorage, AK, USA

2. Hepatitis B Foundation , Doylestown, PA, USA

3. Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine , New York, NY, USA

4. Department of Medicine, Baylor College of Medicine , Houston, TX, USA

5. Department of Medicine, Division of Gastroenterology, VA Puget Sound Health Care System , Seattle, WA, USA

6. Department of Internal Medicine, University of Michigan , Ann Arbor, MI, USA

7. Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic , Rochester, MN, USA

8. Department of Internal Medicine, Division of Digestive and Liver Diseases, UT Southwestern , Dallas, TX, USA

9. Baruch S. Blumberg Institute and Hepatitis B Foundation , Doylestown, PA, USA

Abstract

Abstract 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.

Funder

Hepatitis B Foundation

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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