Harms of Hepatocellular Carcinoma Surveillance
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Purpose of Review
Hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is associated with decreased mortality by enabling early tumor detection. However, the benefits of any cancer screening program must be considered in light of potential physical, financial, and psychological harms, as well as the risk of overdiagnosis. Herein, we summarize the potential harms of HCC surveillance.
To date, two retrospective studies have addressed physical harms of HCC surveillance. Based on these data, 15% to 28% of patients undergoing HCC surveillance experience physical harm including additional cross-sectional imaging or liver biopsy. Although psychological and financial harms have been reported for other cancers, there are currently limited data specific to HCC. An ongoing multi-center prospective study assessing all four types of harms should provide data in the near future.
HCC screening may improve survival by diagnosing tumors at an early stage, but limited sensitivity and specificity of screening tests can result in unintended harms. There is a need for further quality data evaluating both the benefits and harms of HCC surveillance.
KeywordsHepatocellular cancer Screening Risks Overdiagnosis
American Association for the Study of Liver Diseases
European Association for the Study of the Liver
Magnetic resonance imaging
National Comprehensive Cancer Network
Jan Petrasek: Concept and design, drafting of the manuscript
Amit G. Singal: Concept and design, drafting of the manuscript
Nicole E. Rich: Concept and design, drafting of the manuscript
All authors approved the final version of this manuscript.
Amit Singal’s research is supported by the National Cancer Institute R01 CA212008 and R01 CA222900.
Compliance with Ethical Standards
Conflict of Interest
Amit Singal has been on advisory boards and served as a consultant for Wako Diagnostics, Roche, Exact Sciences, Glycotest, Bayer, Eisai, BMS, and Exelixis.
Jan Petrasek and Nicole E. Rich each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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