Hepatocellular carcinoma (HCC) is responsible for more than 800,000 deaths globally. In the United States, HCC is the fastest growing cause of cancer deaths. Viral hepatitis is the leading cause of HCC, followed by alcoholic and nonalcoholic fatty liver disease. The contribution of nonalcoholic fatty liver disease to HCC incidence and mortality is expected to increase in future based on epidemiological and mathematical modeling studies. Routine HCC surveillance (or screening) is recommended in these high-risk groups, which can detect early-stage treatable cancers. Despite its important role in early HCC detection, adherence to surveillance remains low due to multiple provider- and patient-related issues. In order to increase the value of surveillance program to impact prognosis of future HCC cases, surveillance should be tailored according to the emerging risk factors to maximize its cost-effectiveness.
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