More people with alcohol-associated liver disease could benefit from routine liver cancer screening than current guidelines assume

A modeling study by Mass General Brigham researchers found that routine screening provided good value and led to earlier cancer detection, even in patients whose liver cancer risk was below traditional thresholds.

A new study led by investigators from Mass General Brigham found routine liver cancer screening to be cost-effective and life-extending for individuals with alcohol-associated cirrhosis, even when their annual risk of developing liver cancer is less than half the risk level guiding current screening recommendations. Results, published today in Clinical Gastroenterology and Hepatology, underscore the value of routine surveillance for both patients who continue to drink and those who achieved abstinence.

Alcohol-associated cirrhosis is a late stage of liver disease caused by heavy drinking, where scar tissue replaces healthy tissue and impairs proper liver function. This condition significantly increases the risk of developing a common form of liver cancer known as hepatocellular carcinoma (HCC). Since routine HCC screening — consisting of an ultrasound and blood test — can be costly and time-consuming, current guidelines only recommend it for individuals whose annual risk of developing HCC is above 1%. That cutoff comes from older studies, mostly in people with viral hepatitis. Recent data show yearly liver cancer risk in alcohol-associated cirrhosis is often below 1%, so it has been unclear whether these patients should be screened routinely. The new study revealed that biannual screening was beneficial and cost-effective for individuals with an annual HCC risk as low as 0.45%, despite the traditional surveillance threshold being set at 1%.

“Our study shows that the 1% benchmark for screening is out of date for this population. Screening with today's tests and treatments provides good value at a much lower level of risk, and guidelines should be updated to reflect that," said senior author Jagpreet Chhatwal, PhD, Director of the Center for Health Technology Assessment at Mass General Brigham and Associate Professor of Radiology at Harvard Medical School. “Updating the evidence base used to define screening eligibility could help clinicians detect more cancers at an earlier, more treatable stage while using healthcare resources efficiently.”

To determine whether current surveillance guidelines remain cost effective and beneficial for patients with alcohol-associated cirrhosis, Chhatwal and colleagues used a mathematical model incorporating real-world screening data and clinical practices to simulate the trajectory of liver disease in 50 million hypothetical U.S. patients. Health outcomes were measured in quality-adjusted life years, a standard measure for health economics. For every 100,000 patients, surveillance generated an estimated 2,083 additional life-years among active drinkers, and 3,357 additional life-years among abstinent patients.

"A common worry is that screening may not help patients who continue to drink, because they face other serious health risks," said Ali Hajjar, PhD, first author of the study, a former postdoctoral fellow at Mass General Brigham Center for Health Technology Assessment and now an assistant professor at MBS College of Business and Entrepreneurship in Saudi Arabia. "We found that screening was cost-effective in both patients who kept drinking and those who had stopped. Catching cancer earlier gives these patients access to treatments that can extend their lives, so decisions about screening should not depend on drinking status alone."

Authorship: In addition to Chhatwal and Hajjar, Mass General Brigham authors include Jovan Julien, Gizem Nemutlu, H. Mert Sahinkoc, Mary Linton B Peters. Additional authors include Fasiha Kanwal from Baylor College of Medicine.

Disclosures: None.

Funding: This study was funded by the National Institutes of Health (P01CA263025, U01CA23099, K08CA248473, P30DK56338) and the Cancer Prevention and Research Institute of Texas (RP220119, RP150587).

Paper cited: Hajjar A et al. “Optimal Incidence Threshold for Cost-Effective Hepatocellular Carcinoma Surveillance in Alcohol-Associated Cirrhosis,” Clinical Gastroenterology and Hepatology DOI: 10.1016/j.cgh.2026.09.035

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