Hepatocellular carcinoma surveillance in Australia: time to improve the diagnosis of cirrhosis and use liver ultrasound

Timely diagnosis of cirrhosis and HCC surveillance using ultrasound may help improve patient outcomes

Hepatocellular carcinoma (HCC) is an important cause of cancer death in Australia (Box 1). A 2019 report on cancer in Australia, based on data from 1982 to 2015, showed that liver cancer (90% HCC) had the second largest increase (378%) in age‐standardised incidence rates from 1.8 to 8.6 per 100 000 population.1 Unfortunately, there was a matching threefold increase in liver cancer mortality rate from 2.3 deaths to 7.0 per 100 000 population. This was the largest increase for any cancer and, unlike other cancers, is likely an underestimate owing to under‐reporting by some state cancer registries.2 An Australia‐wide epidemiological study found survival from HCC had improved from a median of 2.1 months (95% CI, 1.6–2.6 months) between 1982 and 1984 to 12.1 months (95% CI, 11.2–13.0 months) between 2010 and 2014 (P < 0.001).3 However, survival remains poor and HCC is the only low survival cancer of all the cancers that are rapidly increasing in incidence in Australia.1 The average cost to treat HCC is $50 000 and liver transplantation costs $166 000.4,5 Therefore, with incidence showing no signs of slowing, health system costs will continue to increase substantially in the absence of preventive actions. This article reviews the present evidence for liver ultrasound surveillance in patients with cirrhosis, a major risk factor for the development of HCC.