Japan’s Successful Model of Nationwide Hepatocellular Carcinoma Surveillance Highlighting the Urgent Need for Global Surveillance

Screening and surveillance for early detection of hepatocellular carcinoma (HCC) is currently being promoted in many clinical practice guidelines. These include guidelines issued by the American Association for the Study of Liver Diseases [1], the European Association for the Study of the Liver–the European Organization for Research and Treatment of Cancer (EASL–EORTC) [2], and the Asian Pacific Association for the Study of the Liver [3], as well as those established in Japan by the Japan Society of Hepatology [4, 5]. If HCC is detected at an early stage [e.g., Barcelona Clinic Liver Cancer (BCLC) classification stage 0 or A], curative treatments such as resection, ablation, or transplantation are indicated, with the aim of improving disease prognosis as well as minimizing overall medical costs. Moreover, the abovementioned three curative treatments are highly recommended in the EASL–EORTC guidelines because of substantial evidence supporting their value as therapeutic options. Furthermore, survival is improved if HCC is detected at a stage where these curative treatments are indicated. However, nationwide surveillance for early detection of HCC has been established in Japan, and they have not yet been established in European, Asian, American, or African countries. In Japan, it has become common practice for not only tertiary referral centers, such as university hospitals, cancer centers, and main base hospitals, but also small hospitals and private practitioners to regularly conduct ultrasonography and tumor marker screening for the early detection of HCC in patients at high risk, such as those with cirrhosis and chronic hepatitis B or C. Physicians have lost a number of court cases because their high-risk patients who had been followed-up regularly with screening were diagnosed with HCC larger than 3 cm, for which curative treatments were not applicable. In part, because of such court cases, physicians who specialize in liver disease as well as general physicians nationwide are well aware that patients at high risk for HCC need to be screened regularly. Moreover, starting in the 1990s, the Japan Society of Hepatology designated a person in each of the 47 prefectures responsible for providing educational lectures several times a year to promote © 2012 S. Karger AG, Basel 2235-1795/0014-0141$38.00/0 www.karger.com/lic Liver Cancer 2012;1:141–143