Journal of General Internal Medicine

, Volume 27, Issue 7, pp 861–867 | Cite as

Utilization of Hepatocellular Carcinoma Surveillance Among American Patients: A Systematic Review

  • Amit G. SingalEmail author
  • Adam Yopp
  • Celette S. Skinner
  • Milton Packer
  • William M. Lee
  • Jasmin A. Tiro



Although surveillance for hepatocellular carcinoma (HCC) is recommended in high-risk patients, several studies have suggested it is being underutilized in clinical practice. The aim of our study was to quantify utilization rates for HCC surveillance among patients with cirrhosis and summarize patterns of association between utilization rates and patient socio-demographic characteristics.


We performed a systematic literature review using the Medline database from January 1990 through March 2011 and a manual search of national meeting abstracts from 2008–2010.


Two investigators independently extracted data on patient populations, study methods, and results using standardized forms. A pooled surveillance rate with 95% confidence intervals was calculated. Pre-specified subgroup analysis was performed to find correlates of surveillance utilization.


We identified nine studies that met inclusion criteria. The pooled surveillance rate was 18.4% (95%CI 17.8%–19.0%). Surveillance rates were significantly higher among patients followed in subspecialty gastroenterology clinics compared to those followed in primary care clinics (51.7% vs. 16.9%, p < 0.001). Non-Caucasians and patients of low socioeconomic status had lower surveillance rates than their counterparts.


Utilization rates for HCC surveillance are low, although they are significantly higher among patients followed in subspecialty clinics. Current studies fail to determine why HCC surveillance is not being performed. Future efforts should focus on identifying appropriate intervention targets to increase surveillance rates and reduce socio-demographic disparities.


hepatocellular carcinoma surveillance utilization socio-demographic disparities United States 



All of the listed authors have made substantial contributions to the conception and design of the study, acquisition of data and/or analysis and interpretation of the data, drafting of the manuscript, and final approval of the version to be submitted.

Financial Disclosures

This project was supported in part by grant KL2 RR024983-04 and NIH CTSA grant UL1 RR024982 and the American College of Gastroenterology Junior Faculty Development Award

Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Amit G. Singal
    • 1
    • 3
    • 4
    Email author
  • Adam Yopp
    • 2
    • 4
  • Celette S. Skinner
    • 3
    • 4
  • Milton Packer
    • 3
  • William M. Lee
    • 1
  • Jasmin A. Tiro
    • 3
    • 4
  1. 1.Division of Gastroenterology, Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
  2. 2.Department of SurgeryUniversity of Texas SouthwesternDallasUSA
  3. 3.Department of Clinical SciencesUniversity of Texas SouthwesternDallasUSA
  4. 4.Harold C. Simmons Cancer CenterUT Southwestern Medical CenterDallasUSA

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