New National Standards Set for Liver Cancer Surveillance in the UK
A new guidance paper published in Frontline Gastroenterology and presented at the British Association for the Study of the Liver conference this week reveals a concerning gap in care for liver cancer patients in the UK. The paper, entitled “Hepatocellular Carcinoma Surveillance: Minimum Standards”, sets out national standards for how liver cancer surveillance should be delivered across the NHS. The authors warn that failure to address this gap could have major consequences for early detection and survival rates.
According to the paper, only around 20% of eligible patients attend regular liver cancer surveillance appointments. This is despite clear recommendations for regular monitoring. The majority of people who develop hepatocellular carcinoma (HCC), the most common type of primary liver cancer, already have underlying liver disease. Cirrhosis is present in up to 90% of cases, with the main causes including viral hepatitis, alcohol-related liver disease, and metabolic dysfunction-associated steatotic liver disease (MASLD) linked to rising obesity rates in the UK.
Early detection is crucial for successful treatment of liver cancer. When caught in its early stages, curative treatments such as surgery or ablation are often possible. However, with such a low uptake of surveillance appointments, many patients are still being diagnosed at a later stage, when treatment options are limited and outcomes are poorer.
Lead author of the guidance, Professor Stuart McPherson, consultant Hepatologist at Newcastle Hospitals, stresses the importance of effective surveillance: “Effective surveillance saves lives. But too many patients are missing out. These minimum standards are designed to make sure that everyone at risk is identified, followed up, and supported to stay in the system.”
The guidance also highlights several reasons why patients may not attend regular surveillance appointments. These include fear of a diagnosis, stigma, and difficulties understanding medical letters. Practical issues, such as challenges in accessing scans, the absence of recall systems, and the lack of a national liver cancer registry, also play a role.
Vanessa Hebditch, Director of Policy at Liver Cancer UK, part of the British Liver Trust, expresses concern over the low uptake: “Liver cancer is the fastest rising cause of cancer death in the UK. Finding people with an early stage of liver cancer is vital to ensure that they receive treatment as soon as possible. The fact that patients may be missing out on regular surveillance is deeply concerning. We need to tackle both patient and system barriers so that no one slips through the cracks.”
The new standards call for reliable systems to identify and recall at-risk patients, clear communication using plain language, timely access to follow-up scans, and stronger coordination between NHS liver services. Professor McPherson emphasizes the need for action: “This is a call to action for liver services across the UK. Surveillance only works if people take part, and that means making it easier and more supportive for patients.”
The full guidance is available online in Frontline Gastroenterology: https://fg.bmj.com/content/16/e1/e34
Derick is an experienced reporter having held multiple senior roles for large publishers across Europe. Specialist subjects include small business and financial emerging markets.