Premise

COVID-19 was declared a pandemic by WHO in March 2020 resulting in an unprecedented strain on healthcare systems globally.1 Currently, there is no proven treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, which can cause serious disease with an associated high mortality in a proportion of patients.2 The impact of COVID-19 was first seen in the Chinese healthcare system, but the experiences of Italy, France, Spain, the UK and now the USA underline the gravity of the crisis and the challenge that healthcare professionals will have to overcome globally.3–5

The current pandemic has impacted the management of almost all patients and those with chronic liver disease are no exception. These are uncertain times for both patients and healthcare professionals, while we adjust to the threat posed by COVID-19. An area of specific concern for us is how best to provide hepatocellular carcinoma (HCC) surveillance in chronic hepatitis B (CHB) patients and importantly, how we will prioritise patients for HCC screening at a time of limited resources, concern over potential nosocomial transmission and strict social distancing. While new guidance in relation to COVID-19 suggests that HCC surveillance can be deferred,6 7 it is accepted that patients with cirrhosis, elevated serum alpha-feto protein (AFP) and those with CHB among others should be prioritised. However, we feel that this may also represent an opportunity to review and streamline the risk stratification of CHB patients in whom, and when, we offer HCC surveillance. In this article, we outline the pertinent clinical aspects regarding CHB and HCC, in addition we provide a review of current surveillance guidance and risk stratification models. We reflect on the impact of COVID-19 infection on HCC surveillance and how this crisis could be used as a springboard to determine the timing of initiation of HCC …