# Replace six-monthly ultrasound with a blood test for liver cancer in cirrhosis

Source: https://onco.cc/ideas/idea-prev-hcc-blood-surveillance-cirrhosis/  
OnCo record `idea-prev-hcc-blood-surveillance-cirrhosis` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

People with cirrhosis are meant to have ultrasound scans twice a year, but most do not. A blood test done with their routine liver bloods could catch liver cancer earlier.

## Summary

GALAD and methylation or protein panels show sensitivity above ultrasound for early hepatocellular carcinoma, while adherence to ultrasound surveillance is under 30% in most reported settings. Propose a randomised trial of blood-based surveillance (MRI for positives) versus ultrasound, with early-stage detection and adherence as endpoints.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Blood-based surveillance increases early-stage (BCLC 0/A) HCC detection by at least 20 percentage points, driven primarily by adherence.
- Rationale: A test that rides on existing blood draws removes the main failure point, which is attending for imaging.
- Proposed test: Run a 3,000-patient RCT in cirrhosis clinics with a three-year endpoint.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022): https://doi.org/10.1126/science.aay9040

## Connected records

- cancers: [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [MRI](https://onco.cc/technologies/mri/), [Ultrasound](https://onco.cc/technologies/ultrasound/)
- bottlenecks: [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- key papers: [Early detection of cancer](https://onco.cc/key-papers/paper-crosby-science/)

---
JSON: https://onco.cc/api/v1/entities/idea-prev-hcc-blood-surveillance-cirrhosis.json