Prevention, surveillance, and early detection of hepatocellular carcinoma - a Brazilian multidisciplinary consensus.

Abstract

Background: Hepatocellular carcinoma is a major cause of cancer-related mortality and represents a growing public health challenge.

Aims: To develop multidisciplinary evidence-based recommendations for the prevention and early detection of hepatocellular carcinoma.

Methods: This consensus was coordinated by the Brazilian Society of Surgical Oncology, with the participation of 13 additional national societies. A steering committee defined the key clinical questions addressing prevention, surveillance, and early detection strategies. Recommendation statements were informed by a comprehensive, non-systematic review of the literature conducted using PubMed, Scopus, and the Cochrane Library.

Results: Eighteen recommendations reached consensus, covering three main domains: 1. Primary prevention, including HBV vaccination, timely antiviral therapy for viral hepatitis, and lifestyle interventions for metabolic dysfunction. 2. Secondary prevention, outlining risk-based surveillance strategies for patients with advanced fibrosis or cirrhosis due to hepatitis B virus, hepatitis C virus, or metabolic dysfunction-associated steatotic liver disease. 3. Operational standards for surveillance, emphasizing ultrasound as the cornerstone of monitoring, the importance of structured reporting, management of small nodules, and the selective use of cross-sectional imaging.

Conclusions: These multidisciplinary recommendations provide practical, adaptable guidance for the prevention, surveillance, and early detection of hepatocellular carcinoma. This guidance document aims to reduce the burden of hepatocellular carcinoma and support better clinical outcomes across diverse healthcare settings.

Central message: Prevention and early detection save lives in liver cancer. This Brazilian multidisciplinary consensus integrates the best scientific evidence and the expertise of specialists from across the country to more effectively guide the prevention, identification, and surveillance of hepatocellular carcinoma. By answering key clinical questions and offering practical, easy-to-use recommendations, this document helps physicians and healthcare teams provide better care to people at risk.

Perspectives: This consensus provides practical guidance to improve the prevention and early detection of liver cancer in daily clinical care. The recommendations emphasize raising awareness of hepatocellular carcinoma, stimulating the development of broader surveillance programs, promoting earlier diagnosis, and improving outcomes for patients at risk for developing primary liver cancer.