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Screening the general population for cirrhosis is an important public heath issue. However, it has remained thus far an impossible challenge, like ‘finding a needle in a haystack’, because of the lack of appropriate tools.
In order for health authorities to justify the application of a generalised screening policy, a disease should meet a list of criteria that were established by the WHO more than 40 years ago.1 The first criterion is that the disease should be an important public health problem because of its prevalence and severity. Undoubtedly, chronic liver diseases (CLDs), with a worldwide mortality attributable to cirrhosis of around 800 000 deaths per year, meet this criterion. Although the exact prevalence of cirrhosis is currently unknown, it was recently estimated at 76.3 per 100 000 population aged over 25 in the UK (corresponding to 30 000 people) with an increasing incidence between 1993 and 2001.2 Given the high prevalence of undiagnosed cirrhosis in patients with non alcoholic fatty liver disease (NAFLD) and chronic hepatitis C, these numbers are likely an underestimation. Since compensated cirrhosis often goes undetected for extended periods, a reasonable estimate is that up to 1% of the general population could have histological cirrhosis.3
The second and third criteria are that there should be a recognisable latent stage and an accepted treatment for patients with recognised disease. In the case of cirrhosis, early diagnosis triggers specific monitoring of complications related to portal hypertension and to the increased risk of developing hepatocellular carcinoma. It also enables initiation of specific measures or treatment to prevent disease progression and improve survival (antiviral therapy for viral hepatitis; abstinence from alcohol; lifestyle changes in NAFLD; steroid therapy …