Provider Attitudes Toward Risk-Based Hepatocellular Carcinoma Surveillance in Patients With Cirrhosis in the United States

Nicole J Kim, Karine Rozenberg-Ben-Dror, David A Jacob, Nicole E Rich, Amit G Singal, Elizabeth S Aby, Ju Dong Yang, Veronica Nguyen, Anjana Pillai, Michael Fuchs, Andrew M Moon, Hersh Shroff, Parul D Agarwal, Ponni Perumalswami, Shaun Chandna, Kali Zhou, Yuval A Patel, Nyan L Latt, Robert Wong, Andres Duarte-RojoChristina C Lindenmeyer, Catherine Frenette, Jin Ge, Neil Mehta, Francis Yao, Jihane N Benhammou, Patricia P Bloom, Michael Leise, Hyun-Seok Kim, Cynthia Levy, Abbey Barnard, Mandana Khalili, George N Ioannou

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) surveillance rates are suboptimal in clinical practice. We aimed to elicit providers' opinions on the following aspects of HCC surveillance: preferred strategies, barriers and facilitators, and the impact of a patient's HCC risk on the choice of surveillance modality.

METHODS: We conducted a web-based survey among gastroenterology and hepatology providers (40% faculty physicians, 21% advanced practice providers, 39% fellow-trainees) from 26 US medical centers in 17 states.

RESULTS: Of 654 eligible providers, 305 (47%) completed the survey. Nearly all (98.4%) of the providers endorsed semi-annual HCC surveillance in patients with cirrhosis, with 84.2% recommending ultrasound ± alpha fetoprotein (AFP) and 15.4% recommending computed tomography (CT) or magnetic resonance imaging (MRI). Barriers to surveillance included limited HCC treatment options, screening test effectiveness to reduce mortality, access to transportation, and high out-of-pocket costs. Facilitators of surveillance included professional society guidelines. Most providers (72.1%) would perform surveillance even if HCC risk was low (≤0.5% per year), while 98.7% would perform surveillance if HCC risk was ≥1% per year. As a patient's HCC risk increased from 1% to 3% to 5% per year, providers reported they would be less likely to order ultrasound ± AFP (83.6% to 68.9% to 57.4%; P < .001) and more likely to order CT or MRI ± AFP (3.9% to 26.2% to 36.1%; P < .001).

CONCLUSIONS: Providers recommend HCC surveillance even when HCC risk is much lower than the threshold suggested by professional societies. Many appear receptive to risk-based HCC surveillance strategies that depend on patients' estimated HCC risk, instead of our current "one-size-fits all" strategy.

Original languageEnglish (US)
Pages (from-to)183-193
Number of pages11
JournalClinical Gastroenterology and Hepatology
Issue number1
StatePublished - Jan 2022

Bibliographical note

Funding Information:
Funding This study was supported by National Institutes of Health (NIH) grant number T32DK007742 to Nicole J. Kim; NIH/ National Cancer Institute grant number R01CA196692 and VA CSR&D grant number I01CX001156 to George N. Ioannou; NIH/ National Institute on Alcohol Abuse and Alcoholism grant number K24AA022523 to Mandana Khalili; NIH grant number T32DK007534 to Andrew M. Moon; and National Center for Advancing Translational Sciences /NIH grant numbers UL1TR002319 , KL2TR002317 , and TL1TR002318 to the Institute of Translational Health Sciences at the University of Washington .

Funding Information:
Conflicts of interest These authors disclose the following: Amit G. Singal serves as consultant for Wako/Fujifilm Diagnostics, Exact Sciences, Glycotest, GRAIL, Roche, and Bayer; and is an Associate Editor of Clinical Gastroenterology and Hepatology. Ju Dong Yang serves as consultant for Exact Sciences. Anjana Pillai is on the Speaker’s Bureau for Simply Speaking Hepatitis and Eisai Inc, and Medical Advisory Board for Exelixis and Genentech. Michael Fuchs has received grant support to the McGuire Research Institute from H3B, Exact Sciences, Bayer, and BMS. Shaun Chandna has served on an advisory board for Dova Pharmaceuticals and Targeted Oncology; has served as a speaker for the Chronic Liver Disease Foundation/Focus Medical Communications; has received sponsored travel for research support from Genfit/Covance and Arrowhead Pharmaceuticals; and is expected to receive research funding from Arrowhead Pharmaceuticals. Yuval A. Patel serves as a consultant for Intercept. Catherine Frenette served as a consultant for Wako/Fujifilm Diagnostics. Patricia P. Bloom serves as a consultant for Synlogic Inc. Mandana Khalili is a recipient of research grant (to her institution) from Gilead Sciences Inc and Intercept Pharmaceuticals; and has served as consultant for Gilead Sciences Inc. All other authors disclose no conflicts.

Publisher Copyright:
© 2022 AGA Institute


  • Computed Tomography
  • Liver Cancer
  • Magnetic Resonance Imaging
  • Screening
  • Ultrasound

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.


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