{"entity":{"id":"idea-prev-hcc-blood-surveillance-cirrhosis","kind":"idea","name":"Replace six-monthly ultrasound with a blood test for liver cancer in cirrhosis","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022)","url":"https://doi.org/10.1126/science.aay9040"}],"tags":[],"related":[],"cancers":["hcc"],"sections":["early-detection"],"technologies":["liquid-biopsy","ultrasound","mri"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-early-detection"],"keyPapers":["paper-crosby-science"],"journals":[],"dependsOn":[],"notes":[],"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.","test":"Run a 3,000-patient RCT in cirrhosis clinics with a three-year endpoint.","maturity":"early-clinical","actor":"clinic","cost":"medium","horizonYears":4},"route":"/ideas/idea-prev-hcc-blood-surveillance-cirrhosis/","neighbours":{"cancer":[{"id":"hcc","kind":"cancer","name":"Hepatocellular carcinoma","route":"/cancers/hcc/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"liquid-biopsy","kind":"technology","name":"Liquid biopsy (ctDNA)","route":"/technologies/liquid-biopsy/"},{"id":"mri","kind":"technology","name":"MRI","route":"/technologies/mri/"},{"id":"ultrasound","kind":"technology","name":"Ultrasound","route":"/technologies/ultrasound/"}],"bottleneck":[{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"}],"paper":[{"id":"paper-crosby-science","kind":"paper","name":"Early detection of cancer","route":"/key-papers/paper-crosby-science/"}]}}