The GLOBOCAN project of the International Agency for research on Cancer (IARC) (http://globocan.iarc.fr/ia/World/atlas.html) provides current estimates of the incidence of, mortality and prevalence of major types of cancer, including HCC, at the national leve l, for 185 countries. The GLOBOCAN estimates are presented for 2020, separately for each sex. One-, three- and five-year prevalence data are available for adults only (15 years and older). "• Surveillance for HCC needs to be integrated into existing monitoring systems for disease progression and treatment response for those receiving antiviral therapy. Additional training in the use and expert interpretation of ultrasound imaging for small HCC will also be required.

• Incorporating risk stratification algorithms that help to differentiate the people at high risk of developing HCC from those at low risk may enable more cost-effective implementation of surveillance programmes. In parallel, using abbreviated magnetic resonance imaging sequences and artificial intelligence–based methods for identifying and characterizing new masses in ultrasound, computed tomography and magnetic resonance imaging may reduce the cost and improve the performance of imaging for early HCC detection.
• Liver cancer detection is now also built into multi-cancer early detection assays (such as the GRAIL Galleri® test) that are being developed for regular population-based detection of multiple cancer types and are already available in some countries. If these newer assays can be deployed at lower cost, they may transform the landscape of early detection of liver cancer by removing key barriers to participation with large-scale HCC surveillance and facilitate regular surveillance of those at high risk.
• Surveillance can only improve survival if low- and middle-income countries develop the capacity to find, diagnose and treat small HCC. Effective surveillance programmes require an organized system for regular liver imaging and blood testing, recall programmes and radiology service capacity. In low- and middle-income countries, HCC is usually diagnosed based on specific imaging criteria rather than histology and therefore requires imaging capability and experience. • For surveillance to be effective in improving survival, there must also be staff, facilities and resources to treat small HCC. This includes, especially in low- and middle-income countries, access to expertise in ablation resection (and transplantation), management of advanced liver disease and provision of antiviral therapy to prevent the development of HCC or tumour recurrence following resection."