Del Poggio P, Mazzoleni M, Lazzaroni S, D'Alessio A. Surveillance for hepatocellular carcinoma at the community level: Easier said than done. World J Gastroenterol 2021; 27(37): 6180-6190 [PMID: 34712026 DOI: 10.3748/wjg.v27.i37.6180]
Corresponding Author of This Article
Paolo Del Poggio, MD, Consultant Physician-Scientist, Unità di Epatologia, Policlinico San Marco Zingonia GSD University and Research Hospital Unità Epatologia, Corso Europa Unita 7, Osio Sotto 24040, Bergamo, Italy. paolo.delpoggio51@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Oct 7, 2021; 27(37): 6180-6190 Published online Oct 7, 2021. doi: 10.3748/wjg.v27.i37.6180
Surveillance for hepatocellular carcinoma at the community level: Easier said than done
Paolo Del Poggio, Marzio Mazzoleni, Sergio Lazzaroni, Andrea D'Alessio
Paolo Del Poggio, Sergio Lazzaroni, Unità di Epatologia, Policlinico San Marco Zingonia GSD University and Research Hospital Unità Epatologia, Osio Sotto 24040, Bergamo, Italy
Marzio Mazzoleni, Primary Care Physician, ASST Bergamo, Osio Sotto 24040, Bergamo, Italy
Andrea D'Alessio, Department of Medicine, Policlinico San Marco Zingonia, GSD University and Research Hospital, Osio Sotto 24040, Bergamo, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review, drafting, critical revision and editing; they all have approved the final version.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paolo Del Poggio, MD, Consultant Physician-Scientist, Unità di Epatologia, Policlinico San Marco Zingonia GSD University and Research Hospital Unità Epatologia, Corso Europa Unita 7, Osio Sotto 24040, Bergamo, Italy. paolo.delpoggio51@gmail.com
Received: March 2, 2021 Peer-review started: March 2, 2021 First decision: April 17, 2021 Revised: April 24, 2021 Accepted: August 10, 2021 Article in press: August 10, 2021 Published online: October 7, 2021
Abstract
Surveillance for hepatocellular carcinoma (HCC) in high-risk patients with semiannual ultrasound examinations is advocated by all international guidelines. However, as long as the identification of the population to be screened and the surveillance programs are not well implemented, the real-life impact of HCC surveillance in reducing mortality for HCC cannot be known. We propose a new approach that promotes the identification of cirrhotic patients by primary care physicians (PCPs) and referral of patients to the hepatologist for surveillance. Surveillance should be incorporated, when feasible, in a hub and spoke model of comprehensive hepatology care. Training PCPs to identify cirrhotic patients and performing surveillance in a subspecialist setting are equally important to improve the effectiveness of real-life surveillance and to decrease HCC mortality over time.
Core Tip: Ultrasound surveillance for hepatocellular carcinoma is recommended by all official guidelines for high-risk patients, but its uptake at the community level is low. We discuss the obstacles hampering its implementation and propose a hub and spoke model network for the effective delivery of surveillance in the real world setting.
