(HealthDay News) — For patients with chronic liver disease, hepatocellular carcinoma (HCC) screening can identify patients at an earlier stage, but the benefits and harms of screening are unclear, according to a study published online in the Annals of Internal Medicine.

Devan Kansagara, MD, from the Portland Veterans Affairs Medical Center in Oregon, and colleagues conducted a systematic literature review to examine the benefits and harms of routine screening for HCC in patients with chronic liver disease. Twenty-two studies met the inclusion criteria.

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The researchers found that evidence of the effects of screening was very low strength. Based on one large trial, periodic ultrasonographic screening correlated with decreased HCC mortality (rate ratio, 0.63), but methodological flaws limited the study.

No survival benefit was seen with periodic α-fetoprotein screening in a trial involving patients with hepatitis B.

Based on 18 observational studies, patients that underwent screening had earlier-stage HCC than patients who were diagnosed clinically, but the effects were confounded by lead- and length-time.

No survival differences were found for shorter (3- to 4-month) and longer (6- to 12-month) screening intervals, based on two trials. Screening harms were poorly studied.

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“Screening tests can identify early-stage HCC, but whether systematic screening leads to a survival advantage over clinical diagnosis is uncertain,” the researchers wrote.

Authors of an accompanying editorial pointed out that waiting for better evidence can be difficult and raises questions about what is appropriate in clinical practice.

“Given the high mortality from HCC and the high costs of delivering a truly effective program of early detection and treatment, better evidence is imperative,” they wrote.

“We hope that the VHA and other health systems can collaborate to develop such evidence so patients and their clinicians can be confident they are getting (and delivering) the best care available.”


  1. Kansagara D, Papak J, Pasha AS et al. Screening for Hepatocellular Carcinoma in Chronic Liver Disease: A Systematic Review. Ann Intern Med. 2014;doi:10.7326/M14-0558.
  2. Atkins D, Ross D, Kelley M. Acting in the Face of Uncertainty. Ann Intern Med. 2014;doi:10.7326/M14-1344.