Surveillance for hepatocellular carcinoma at the community level: Easier said than done

Figure 1 Hepatocellular carcinoma diagnosis before and after implementation of the training program in the area where primary care physicians were trained and in other areas where primary care physicians were not trained. White bars indicate the total number of hepatocellular carcinomas. Black bars indicate hepatocellular carcinomas diagnosed by surveillance. In the intervention area the diagnoses under surveillance increased from 85 of 244 (34.8%) to 105 of 190 (55%) after training (Δ = + 20.5%, P < 0.001). The diagnoses increased from 21 of 81 (25.9%) to 20 of 51 (39%) in other areas (Δ = + 13.1%, P = 0.11, not significant).

Figure 2 Hub and spoke model for the diagnosis and follow-up of cirrhotic patients by primary care physicians in the province of Bergamo. In the model, ultrasound surveillance and follow-up of cirrhotics are performed by hepatologists in general hospitals. HBV: Hepatitis B virus; HCV: Hepatitis C virus; OLT: Orthotopic liver transplantation; PCP: Primary care physicians.