title: Factors affecting screening for hepatocellular carcinoma.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is a frequent cancer. Its prognosis is highly dependent on early diagnosis. Patients at risk for developing HCC should be enrolled in a surveillance programme. Nevertheless, many patients at risk are not regularly screened. We aimed at exploring the characteristics that affect enrolment in a surveillance programme.
  
  
  METHODS
  The characteristics of the patients included in the prospective Bern HCC cohort between August 2010 and August 2011 were analysed according to their participation in a surveillance programme.
  
  
  RESULTS
  Among the 82 patients included in the cohort during this period of time, 48 were in a surveillance program before the diagnosis of HCC. Thirty five percent of cirrhotic patients were not screened. Age, sex, level of education, Child-Pugh status and MELD score were similar between the patients who were screened and those who were not screened. Patients with a private insurance and patients treated by a liver specialist were more frequently enrolled in a surveillance program. Sixty seven percent of the screened patients were eligible for curative treatment whereas only 15% of the non-screened patients were.
  
  
  CONCLUSIONS
  In conclusion the surveillance of patients at risk for developing HCC increases their chances to be diagnosed at an early stage to allow curative treatment. More than one third of cirrhotic patients were not regularly screened. Patients with chronic liver disease should be referred to identify those at risk and enrol them in a surveillance program.
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern. Switzerland.
authors.forename: Farah
authors.initials: F
authors.lastname: Al Hasani
authors.affiliation: University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern. Switzerland.
authors.forename: Marina
authors.initials: M
authors.lastname: Knoepfli
authors.affiliation: Institut of Social and Preventive Medicine, University of Bern. Switzerland.
authors.forename: Armin
authors.initials: A
authors.lastname: Gemperli
authors.affiliation: Department of Oncology, Inselspital, University of Bern. Switzerland.
authors.forename: Attila
authors.initials: A
authors.lastname: Kollar
authors.affiliation: University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern. Switzerland.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Banz
authors.affiliation: Department of Radiology, Inselspital, University of Bern. Switzerland.
authors.forename: Joachim
authors.initials: J
authors.lastname: Kettenbach
authors.affiliation: Institut of Social and Preventive Medicine, University of Bern. Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.affiliation: Hepatology, Department of Clinical Research, University of Bern. Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern. Switzerland.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dufour
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000379:methods*; D042241:Early Diagnosis; D004522:Educational Status; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors