ideasIdea
Replace six-monthly ultrasound with a blood test for liver cancer in cirrhosis
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.
GALAD and methylation or protein panels show sensitivity above ultrasound for early hepatocellular carcinoma, while adherence to ultrasound surveillance is under 30% in many settings. Propose a randomised trial of blood-based surveillance (MRI for positives) versus ultrasound, with early-stage detection and adherence as endpoints.
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.
What would test it
Run a 3,000-patient RCT in cirrhosis clinics with a three-year endpoint.
Maturity
early clinical
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks
- Most lethal cancers are found late · Screening exists for only a few cancers. Pancreatic, ovarian, liver, oesophageal and most lung cancers are found when cure is unlikely.