Daijiworld Media Network - New Delhi
New Delhi, Sep 25: A new expert review has called for more organised and consistent surveillance for hepatocellular carcinoma (HCC) across Europe to improve early detection of the disease.
HCC is the most common form of primary liver cancer and is often diagnosed at an advanced stage, when curative treatment options are limited. The review examined current surveillance practices and drew lessons from programmes implemented in different parts of the world.
Current guidelines recommend liver ultrasound every six months, with or without a blood test to measure serum alpha-fetoprotein (AFP), for people at high risk of HCC. This primarily includes patients with cirrhosis and certain people with chronic hepatitis B.
However, the researchers found that surveillance remains fragmented across Europe. Patients who are eligible for screening may not be identified, invited or recalled consistently, while responsibility for surveillance may be divided among primary care, hepatology and radiology services.
Patient participation can also be affected by limited awareness of the importance of surveillance, transport difficulties, socioeconomic disadvantages and other competing health problems. These factors can result in missed examinations and delays in detecting cancer.
The review also highlighted concerns over the quality of ultrasound examinations. Although ultrasound is widely available, non-invasive and relatively inexpensive, its effectiveness can vary.
Obesity, nodular cirrhosis and metabolic liver disease can make it more difficult to detect small tumours. The experience of the operator and the quality of the examination can also influence the ability to identify early-stage cancers.
The researchers called for minimum quality standards, appropriate training and regular audits of surveillance services. They noted that patients whose ultrasound examinations provide inadequate visualisation may need alternative imaging methods, although this would have implications for healthcare costs and available capacity.
The review also examined emerging approaches such as abbreviated magnetic resonance imaging (MRI), new blood-based biomarkers and personalised risk models. These methods could potentially improve HCC surveillance in the future, but the authors said further validation is needed before they can replace established ultrasound-based surveillance pathways.
According to the review, structured surveillance programmes could improve participation and early diagnosis by maintaining patient registers, sending automated invitations and reminders, establishing clear referral pathways and ensuring rapid follow-up of abnormal findings.
The researchers said programmes should also routinely monitor surveillance uptake, the quality of scans, the stage at which cancer is diagnosed, treatment and patient outcomes.
Experience from programmes outside Europe suggests that coordinated surveillance systems can improve participation and increase the detection of cancers at a stage when treatment may still be possible. However, the review noted that such approaches need to be adapted to differences in national healthcare systems, disease patterns and available resources.
The authors also acknowledged limitations in the evidence supporting HCC surveillance. Much of the reported survival benefit has come from observational studies, which can be affected by lead-time and selection biases.
Randomised evidence demonstrating a reduction in mortality remains limited and has largely been derived from patients with hepatitis B.
Despite these uncertainties, the researchers concluded that Europe should focus on developing organised, equitable and quality-assured HCC surveillance systems.
They said improving the reliable delivery and quality of existing surveillance methods could provide a more immediate benefit than waiting for newer technologies to become available and fully validated.