There are medical conditions that increase a person’s risk of developing liver cancer, and these risk factors include hepatitis B and C virus infections, alcohol liver disease, and non-alcoholic fatty liver disease. People at risk for liver cancer can have none, one, or more than one of the risk factors. These risk factors can lead to fibrosis (potentially reversible) and subsequent cirrhosis (irreversible) of the liver, which in turn can lead to liver cancer. Current recommendation by medical groups is to screen adult patients seeking primary care suspected to have risk factors, such as hepatitis or alcohol use disorder, one risk factor at a time, but screening rates are low. Due to lack of...

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There are medical conditions that increase a person’s risk of developing liver cancer, and these risk factors include hepatitis B and C virus infections, alcohol liver disease, and non-alcoholic fatty liver disease. People at risk for liver cancer can have none, one, or more than one of the risk factors. These risk factors can lead to fibrosis (potentially reversible) and subsequent cirrhosis (irreversible) of the liver, which in turn can lead to liver cancer. Current recommendation by medical groups is to screen adult patients seeking primary care suspected to have risk factors, such as hepatitis or alcohol use disorder, one risk factor at a time, but screening rates are low. Due to lack of strong data, there is no recommendation to screen patients for non-alcoholic fatty liver disease. The proposed work has two overall goals: (1) to identify the best way to screen patients in primary care clinics for these risk factors for fibrosis or cirrhosis and (2) to manage risk factors to decrease the risk of worsening fibrosis. This study is significant because it will identify the most efficient and cost-effective way to simultaneously assess persons presenting to a primary care settings for all of the major risk factor conditions that can lead to fibrosis or cirrhosis and yield high-quality data on whether a tailored behavioral intervention can help reduce fibrosis in persons at risk for liver cancer. We will also provide evidence to support a screening strategy for non-alcoholic fatty liver disease, for which currently no screening strategy exists. We will create a web-based risk assessment tool to be used during clinic visits, and these could be widely shared to many others in the state and beyond. This project has the potential to change the field of liver cancer research by providing primary care providers evidence-based screening and management strategies to detect and treat medical conditions that are risk factors for fibrosis or cirrhosis.

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