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Chen et al. Hepatoma Res 2019;5:12 Hepatoma Research
DOI: 10.20517/2394-5079.2019.03

Review Open Access

Liver cancer screening in China: practices and its
extended questions

Jian-Guo Chen , Yong-Hui Zhang , Ling-Ling Lu , Hai-Zhen Chen , Ai-Guo Shen , Yuan-Rong Zhu 1
2
1
2
1,2
1
1 Department of Epidemiology, Qidong Liver Cancer Institute, Qidong 226200, China.
2 Department of Epidemiology, Cancer Hospital/Institute, Nantong University, Nantong 226361, China.
Correspondence to: Prof. Jian-Guo Chen, Department of Epidemiology, Qidong Liver Cancer Institute, Qidong 226200, China; Cancer
Hospital/Institute, Nantong University, Nantong 226361, China. E-mail: chenjg@ntu.edu.cn

How to cite this article: Chen JG, Zhang YH, Lu LL, Chen HZ, Shen AG, Zhu YR. Liver cancer screening in China: practices and its
extended questions. Hepatoma Res 2019;5:12. http://dx.doi.org/10.20517/2394-5079.2019.03

Received: 7 Jan 2019 First Decision: 6 Mar 2019 Revised: 3 Apr 2019 Accepted: 3 Apr 2019 Published: 26 Apr 2019

Science Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Huan-Liang Wu

Abstract
Screening for liver cancer (hepatocellular carcinoma) in China started in early 1970s with the application of alpha-
fetoprotein (AFP) in high-incidence regions. It has been extended to nationwide areas, emerging from the concepts
of conducting screening in populations at-risk with positive hepatitis B surface antigen to the practice programs in
rural and urban areas, and finally to the development of recommendations to guide medical practice for health care
providers. The implementation of screening for liver cancer has resulted in earlier detection and hence the early
curable treatment for patients who have gained short- or long-term survival, and even reduction in mortality rates,
although these outcomes are more anecdotal than rigorously evidence-based. AFP or ultrasound examination has
been considered as sensitive and specific methods for early detection but are with limitations. The combined use of
these two modalities for screening populations at-risk every six months seems to have been reached consensus. The
feasibility of screening for liver cancer is still debated because of differing opinions and even opposition to the choice
of targeted sub-populations, the intrinsic necessity, and the contributions of the main risk factors among Western
countries and China/Asian areas. Yet, the over 51% of global burden of liver cancer is in China, the solution to the
early detection and treatment of liver cancer should fully consider the actual situation in China. The effectiveness of
screening for liver cancer is worthy of anticipation.

Keywords: Hepatocellular carcinoma, screening, alpha-fetoprotein, ultrasound, early detection, high risk population

INTRODUCTION
Liver cancer [hepatocellular carcinoma (HCC)] is currently the second leading cause of cancer deaths
[1]
worldwide, accounting for about 8.2% of the global burden of cancer . China has the most patients with
© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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