Which group should be screened for hepatocellular carcinoma?

• A. Individuals aged 50 years and older
• B. Individuals with a 30 pack-year history of smoking
• C. Individuals with alcohol use disorder
• D. Individuals with liver cirrhosis

Answer: (B)

Screening for hepatocellular carcinoma is focused on those at the highest risk, especially people with liver cirrhosis. Cirrhosis markedly increases the annual risk of HCC regardless of how it developed, so regular surveillance is recommended to detect tumors early when treatment is most effective. The standard approach is ultrasound every six months, sometimes with alpha-fetoprotein as an adjunct.

Age by itself, a long smoking history, or alcohol use disorder without cirrhosis does not justify routine HCC screening. Alcohol use can raise risk only if it leads to cirrhosis, but without cirrhosis the benefit of screening is not established.