title: Low use of surveillance and early diagnosis of hepatocellular carcinoma in Norway--a population-based cohort study.
abstract: OBJECTIVE
  Curative treatment of hepatocellular carcinoma (HCC) is dependent on early diagnosis. Surveillance of patients at high risk for HCC is a key determinant to achieve this goal, but may be an underutilized tool. The aim of this study was to determine the rate of pre-diagnosis surveillance in patients with HCC in a large population-based cohort and to assess to what extent cirrhosis was known prior to the diagnosis of HCC.
  
  
  METHODS
  All patients diagnosed with HCC during 2000-2009 in The South-Eastern Regional Health Authority, representing 56% of the Norwegian population, were identified from The National Cancer Registry and the medical records were reviewed.
  
  
  RESULTS
  Fifteen out of 486 patients (3%) were diagnosed by surveillance. Potential curative treatment was offered to 58% of the patients who underwent surveillance as opposed to 15% in the non-surveillance group. Only age ≤ 65 years was an independent predictor of screening in a multivariate model. Almost two thirds of the patients with cirrhosis were unrecognized prior to the HCC diagnosis. Two hundred and fourteen patients (44%) were non-cirrhotics.
  
  
  CONCLUSIONS
  Regular HCC surveillance in at-risk populations is virtually not applied in Norway and this may contribute to inferior overall survival. Failure to recognize cirrhosis and a high rate of HCC in non-cirrhotic patients will be limiting factors for the overall effectiveness of a potential surveillance program.
authors.affiliation: Department of Infectious Diseases, Medical Division, Akershus University Hospital, Lørenskog, Norway. arne.eskesen@ahus.no
authors.forename: Arne Nørgaard
authors.initials: AN
authors.lastname: Eskesen
authors.forename: Kristian
authors.initials: K
authors.lastname: Bjøro
authors.forename: Einar Martin
authors.initials: EM
authors.lastname: Aandahl
authors.forename: Pål Dag
authors.initials: PD
authors.lastname: Line
authors.forename: Espen
authors.initials: E
authors.lastname: Melum
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009664:Norway; D012307:Risk Factors