Hepatocellular carcinoma (HCC), the main primitive liver cancer, occurs almost exclusively in patients with cirrhosis. Only small tumors are accessible to curative treatments. Such tumors being asymptomatic, their detection needs to perform regular surveillance, using ultrasonography every 6 months, in patients with compensated cirrhosis. Several cues suggest that more than 75% of patients with HCC have not been included in such a surveillance program or that screening has been performed using inadequate modalities. The main paths to improve this status include: a) to increase the detection of patients with cirrhosis in the general population by sensitizing healthcare professionals to the diagnosis of cirrhosis and by developing the use of non invasive diagnostic methods; b) to extend HCC screening to all patients with compensated cirrhosis and to educate healthcare professionals about precise modalities; c) to develop a multidisciplinary approach to ensure the appropriate management of patients.