People missing out on life-saving liver cancer checks, experts warn

New UK guidance published in Frontline Gastroenterology and being presented this week at the UK’s leading liver conference reveals a serious gap in care, with estimates suggesting only around one in five patients who are eligible for liver cancer surveillance attend regularly. 

Experts worry this could have major consequences for early detection and survival.

The paper, Hepatocellular Carcinoma Surveillance: Minimum Standards, sets out new national standards for how liver cancer surveillance should be delivered across the NHS. Despite clear recommendations for regular monitoring, it's estimated a significant number of patients at risk are not consistently taking part in surveillance programmes.

Most people who develop hepatocellular carcinoma (HCC), the most common type of primary liver cancer, already have liver disease. 

Cirrhosis is present in up to 90% of cases. The main causes include viral hepatitis, alcohol-related liver disease and, increasingly, metabolic dysfunction-associated steatotic liver disease (MASLD) linked to rising obesity rates in the UK.

Early detection through regular checks is vital. When liver cancer is found early, curative treatments such as surgery or ablation are often possible. However, the current low uptake means many people are still diagnosed at a later stage, when treatment options are limited and outcomes are poorer.

“Effective surveillance saves lives,” Professor Stuart McPherson, lead author of the guidance and consultant Hepatologist at Newcastle Hospitals told That's Health.

“But too many patients are missing out. These minimum standards are designed to make sure that everyone at risk is identified, followed up and supported to stay in the system.”

The guidance highlights several reasons why patients may not attend regularly. These include fear of a diagnosis, stigma, and difficulties understanding medical letters. Practical issues also play a role, such as challenges in accessing scans, the absence of recall systems, and the lack of a national liver cancer registry.

Vanessa Hebditch, Director of Policy, at Liver Cancer UK, part of the British Liver Trust, said: “Liver cancer is the fastest rising cause of cancer death in the UK. Finding people with an early stage of liver cancer is vital to ensure that they receive treatment as soon as possible.

“The fact patients may be missing out on regular surveillance is deeply concerning. We need to tackle patient and system barriers so that no one slips through the cracks.”

The new standards call for reliable systems to identify and recall at-risk patients, clear communication using plain language, timely access to follow-up scans and stronger coordination between NHS liver services.

The guidance has been discussed at the British Association for the Study of the Liver conference taking place in Belfast between 8th and 10th October, today.

“This is a call to action for liver services across the UK,” continues Professor McPherson. “Surveillance only works if people take part, and that means making it easier and more supportive for patients.”

The full guidance is available online in Frontline Gastroenterology: https://fg.bmj.com/content/16/e1/e34

https://britishlivertrust.org.uk

Urgent action needed as new research reveals gaps in fatty liver disease diagnosis and care

New research released to coincide with Global Fatty Liver Day has found that fatty liver disease is being consistently overlooked, leading to late diagnosis. 

This discovery comes from analysis of a survey of patients with fatty liver disease, which found that more than half reported receiving no support following their diagnosis, and a third were diagnosed at a late stage.

Fatty liver disease, also known as MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease), is estimated to affect up to 1 in 5 people in the UK. The main risk factors are being overweight, an unhealthy diet or living with type 2 diabetes.

A survey conducted by the British Liver Trust found that among 687 people living with MASLD:

• 68% were overweight or obese

• 35% had type 2 diabetes

More than half (55%) said they had received no support with weight management, eating a healthy diet or physical activity, which is the cornerstone for successful treatment of this disease. In the early stages, reducing weight and improving diet can either halt disease progression or even reverse liver damage. 

Additionally, over a third of respondents said their diagnosis came at a late stage, when it was too late for effective treatment.

With an estimated two thirds of the UK population classed as overweight or obese, the charity is calling for better awareness among both the general population and healthcare professionals. The British Liver Trust is urging widespread, systematic case finding, including routine testing and liver scanning for people at risk—to enable earlier diagnosis and better outcomes. 

The charity also highlights the need for new treatments to be introduced alongside comprehensive education for healthcare professionals, to ensure patients receive appropriate support at the right time.

MASLD is affecting an increasing number of people across the UK. Mortality rates in England alone rose by 44% between 2019 and 2023, with the highest rates seen in the North of England.

Pamela Healy OBE, CEO at the British Liver Trust, told That's Health: “For too long, widespread misunderstandings around liver health have meant that large numbers of people are unaware of the risks to their liver from being overweight, or from eating too much unhealthy or ultra-processed food. People are frequently told how these lifestyle factors increase their risk of heart disease and type 2 diabetes, but the risk of fatty liver disease is rarely discussed.

“We want to see MASLD to be given the same attention as other major conditions, and we need effective changes to ensure that everyone at risk receives the right treatment at the right time.”

Sara’s father was told he had a fatty liver in 2014 and only received one scan in 2016. In 2024, he was diagnosed with MASLD and died just four months later in July 2024, aged 62. Sara and her family are still trying to come to terms with his tragic, and ultimately preventable, death: “If we’d got that MASLD diagnosis a little bit sooner, if he’d just had a few more weeks, and if he had been put under surveillance a few years earlier, they would have seen his liver was getting worse and it wouldn’t have got to this point.”

“MASLD is a growing public health concern across the UK,” said Professor Philip Newsome, a leading liver expert from King’s College Hospital London and medical advisor to the British Liver Trust. “We are seeing promising advances in research with several new treatments showing encouraging results. However, there is an urgent need to translate these developments into clinical practice, ensuring early detection and better treatments are embedded within the NHS to deliver real benefits for patients.”

https://britishlivertrust.org.uk