title: Factors Influencing Surveillance for Hepatocellular Carcinoma in Patients with Liver Cirrhosis.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related mortality worldwide, and a rising cause of cancer mortality in the U.S. Liver cirrhosis is the major risk factor for HCC. Surveillance of persons with cirrhosis facilitates early detection and improves outcomes. We assessed the surveillance rate for HCC within a major academic health system and identified factors influencing surveillance.
  
  
  METHODS
  We examined the surveillance rate for HCC using liver ultrasound, CT, or MRI, and factors influencing surveillance in a cohort of 369 Minnesota residents with cirrhosis seen at the Mayo Clinic between 2007 and 2009.
  
  
  RESULTS
  Ninety-three percent of cirrhosis patients received at least one surveillance study, but only 14% received the recommended uninterrupted semiannual surveillance. Thirty percent received ≥75% of recommended surveillance, and 59% received ≥50% of recommended surveillance. Factors increasing surveillance included gastroenterology or hepatology specialist visits (p < 0.0001), advanced liver disease as assessed by hepatic encephalopathy (p = 0.0008), and comorbid illness as assessed by diabetes mellitus (p = 0.02). Age, sex, race, residence, cirrhosis etiology, or number of primary care visits did not significantly affect the rate of surveillance.
  
  
  CONCLUSIONS
  While the rate of surveillance in a major academic health system was higher than reported in other studies, surveillance was heavily dependent on visits to a subspecialist. This suggests a major and urgent national need to improve identification of individuals at risk for HCC in the primary care setting and the initiation and maintenance of surveillance by primary care practitioners.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Hager A
authors.initials: HA
authors.lastname: Ahmed Mohammed
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Ju Dong
authors.initials: JD
authors.lastname: Yang
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Nasra H
authors.initials: NH
authors.lastname: Giama
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Jonggi
authors.initials: J
authors.lastname: Choi
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Hawa M
authors.initials: HM
authors.lastname: Ali
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Kristin C
authors.initials: KC
authors.lastname: Mara
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn., USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Russell H
authors.initials: RH
authors.lastname: Wiesner
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Leise
authors.affiliation: Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Roberts
keywords: Cirrhosis; Hepatocellular carcinoma; Liver cancer; Surveillance/screening