Screening for advanced steatotic liver disease

Abstract

Steatotic liver disease often progresses asymptomatically, with the risk of advancing to cirrhosis and liver cancer. Early detection of advanced liver disease through screening presents an opportunity to prevent severe outcomes, if said screening is linked to effective intervention. This Review evaluates the feasibility of screening for advanced steatotic liver disease through the lens of the Wilson and Jungner criteria. The assessment focuses on the presence of a presymptomatic stage as a target for screening, advances in diagnostic tests, cost-effectiveness, the availability of effective treatments, and the difficult task of balancing harms against benefits of screening. Additional criteria are proposed to address contemporary challenges, including ensuring equitable access, implementing long-term programme evaluation, and developing strategies to minimise psychosocial harm. The long-term benefits of screening-particularly in reducing liver-related morbidity and mortality remain unclear-highlighting the need for large-scale randomised trials with long-term follow-up.