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


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

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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