Opportunities to improve surveillance of hepatocellular carcinoma in Australia

The incidence and impact of primary liver cancer in Australia is growing. Over the past two decades, there have been major gains in the fight against cancer in Australia. Despite our ageing population, overall cancer mortality has decreased.1 Yet, primary liver cancer remains an outlier to this trend: in 2019, the estimated incidence of primary liver cancer was more than four times higher (10.1 cases per 100 000) than in 1982 (2.2 cases per 100 000), a faster increase than any other type of cancer in Australia. Primary liver cancer is also a low survival cancer, with a five-year survival of only 22%.

Hepatocellular carcinoma (HCC) accounts for over 85% of primary liver cancer, and usually develops in the setting of chronic liver disease, with up to 90% of cases occurring in people with liver cirrhosis. Previously, viral hepatitis and alcohol-related liver disease were the most common aetiologies of HCC. However, metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly emerging as a major cause of HCC. In contrast to many other cancers, the at-risk population for HCC is well defined. Moreover, when detected at an early stage, patients can be offered curative treatments. Surveillance for HCC in individuals at risk with six-monthly liver ultrasound scans, with or without the α-fetoprotein (AFP) blood test, improves HCC survival, is recommended in guidelines and is cost-effective in the Australian context.