Liver cancer screening: Who needs it and what it entails

Living with liver disease means staying vigilant about your health. One of the most important steps you can take is regular screening for hepatocellular carcinoma (HCC), the most common type of liver cancer.  

While the idea of cancer screening can feel overwhelming, understanding what’s involved — and why it matters — can help you feel more confident about this potentially life-saving care.  

The good news? The screening process is simple, safe, and could catch problems at their most treatable stage. Here’s what you need to know about these important tests. 

What is hepatocellular carcinoma (HCC)? 

Hepatocellular carcinoma, or HCC, is the most common type of primary liver cancer. It typically develops in people who already have chronic liver disease or liver damage. While HCC is serious, catching it early makes a significant difference in treatment options and outcomes. 

Why screening matters 

When liver cancer is found early — before symptoms appear — treatment is more likely to be successful. Early-stage HCC can often be treated with procedures like tumor removal, liver transplant, or targeted therapies that may not be options once the cancer has advanced, according to clinical guidelines from the American Association for the Study of Liver Diseases (AASLD). 

Regular screening helps detect HCC at its most treatable stage, when you may still feel completely fine. That’s why staying on schedule with your screenings is so important. 

Who needs screening? 

The AASLD recommends screening for people in certain high-risk groups. You should talk to your doctor about liver cancer screening if you have: 

Cirrhosis (liver scarring) from any cause, including: 

• Hepatitis B or hepatitis C infection 

• Fatty liver disease 

• Alcohol-related liver disease 

• Autoimmune liver disease 

• Other chronic liver conditions 

Chronic hepatitis B infection, even without cirrhosis, if you also have: 

• A family history of liver cancer 

• Lived in a country with high hepatitis B exposure. (A country is considered high risk if about 8 out of every 100 people have hepatitis B.) 

• Other risk factors your doctor identifies 

Your health care provider can help determine if screening is right for you based on your individual health history. 

What does screening involve? 

Liver cancer screening typically includes two tests, both performed every six months: 

1. Liver ultrasound 

This imaging test uses sound waves to create pictures of your liver. It’s the same technology used to view babies during pregnancy. 

• Takes about 30 minutes 

• Completely painless 

• No radiation exposure 

During the ultrasound, a technician will apply gel to your abdomen and move a small device (transducer) across your skin. You’ll lie on your back or side while images of your liver are captured. 

2. AFP blood test 

Alpha-fetoprotein (AFP) is a protein that can be elevated in people with liver cancer. Cleveland Clinic notes that this marker helps identify changes that might indicate HCC. This simple blood draw helps identify changes. 

The blood test is done at the same time as other routine lab work and requires no special preparation. 

Is screening safe? 

Yes. Ultrasound is one of the safest imaging tests available, according to information from the Cleveland Clinic. It doesn’t use radiation, causes no discomfort, and has no known risks. The AFP blood test carries the same minimal risks as any blood draw — slight bruising or soreness at the needle site. 

Your role in screening 

Staying healthy when you have liver disease means being proactive about your care. Here’s how you can help: 

Keep your appointments. Screening works best when done regularly — every six months as recommended. Mark your calendar and don’t skip tests, even if you’re feeling well. 

Talk to your doctor about your risk. Be open about your liver disease history, any symptoms you’re experiencing, and questions you have about screening. 

Follow up on results. If your screening shows anything concerning, work with your health care team to determine next steps quickly. 

Take care of your liver. Avoid alcohol, maintain a healthy weight, take medications as prescribed, and manage conditions like diabetes that can affect liver health. 

Next steps 

If you have cirrhosis or chronic hepatitis B, ask your doctor if liver cancer screening is right for you. Early detection gives you the best chance for successful treatment and better long-term health outcomes. 

Check your benefits to learn more about coverage for ultrasound and AFP testing and use our Find a Provider tool to find in-network services and providers near you. 

See our sources:  
Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma: American Association for the Study of Liver Diseases 
Liver ultrasound: Cleveland Clinic 
What Are Tumor Markers?: Cleveland Clinic 
Global virus hepatitis: Centers for Disease Control and Prevention