Surveillance of patients at risk of liver cancer: Expert opinions.

Liver cancer surveillance is supported by a strong rationale and observational research; however, evidence from randomised trials is lacking, limiting support from organisations beyond hepatology, such as national screening committees. The absence of such trials has been acknowledged in the hepatology community for over 25 years. Screening is often performed in low-prevalence populations, and screening tests are imperfect. As a result, most positive results are false positives. Although novel screening modalities are being investigated to complement or replace ultrasound for liver cancer surveillance, challenges remain, particularly regarding the weak evidence base. The ultimate aim of liver cancer surveillance is to improve survival, but many patients do not experience notable benefits due to low cancer incidence, limited test sensitivity, and competing mortality risks. Implementing risk-based hepatocellular carcinoma surveillance, as recommended by some guidelines, may enhance outcomes by tailoring surveillance to individual patient risk profiles. Many risk prediction models exist, and they have been implemented for patients with chronic hepatitis B. Stronger evidence, persistent advocacy, and consultations with national and international screening committees could pave the way for improved liver cancer surveillance practices.