Australia does not have a population screening program for HCC. Patients at risk of HCC should be in a surveillance program, including patients with non-alcoholic fatty liver disease who have advanced liver disease. Patients under surveillance have their tumours detected at an earlier stage and therefore have better outcomes, including improved survival.

Follow guidelines for screening appropriate populations, which are summarised in the National Cancer Institute Liver cancer screening PDQ.

All patients with cirrhosis should be in a screening program. In patients with HBV (without cirrhosis), screening should begin according to the following guide:

• African-background patients from age 20
• Asian-background male patients from age 40
• Asian-background female patients from age 50
• Caucasian patients from age 50.

The most recent guidelines from the American Association for the Study of Liver Diseases recommend that HCC surveillance be based on a six-monthly liver ultrasound in high-risk groups with or without alpha-fetoprotein (AFP) (Marrero et al. 2018).

There is no evidence for more frequent ultrasounds (less than six months) or for using other imaging (CT, MRI) as a first-line screening.

Screening with AFP is widely used and included in the Australian guidelines. Changes in AFP in patients with chronic viral hepatitis in treatment or post treatment are important.

Patients who have viral chronic hepatitis and a family history of HCC have an increased risk of HCC and need to undergo six-monthly surveillance with ultrasound.

For basic information about cancer in the family, visit the Centre for Genetics Education website.