Many countries have incorporated population screening programmes for cancer, such as colorectal and lung cancer, into their health-care systems. Cirrhosis is more prevalent than colorectal cancer and has a comparable age-standardized mortality rate to lung cancer. Despite this fact, there are no screening programmes in place for early detection of liver fibrosis, the precursor of cirrhosis. In this Perspective, we use insights from colorectal and lung cancer screening to explore the benefits, challenges, implementation strategies and pathways for future liver fibrosis screening initiatives. Several non-invasive methods and referral pathways for early identification of liver fibrosis exist, but in addition to accurate detection, screening programmes must also be cost-effective and demonstrate benefit through a reduction in liver-related mortality. Randomized controlled trials are needed to confirm this. Future randomized screening trials should evaluate not only the screening tests, but also interventions used to halt disease progression in individuals identified through screening.

许多国家已将结直肠癌和肺癌等癌症的人口筛查计划纳入其医疗保健系统。肝硬化比结直肠癌更为普遍，并且其年龄标准化死亡率与肺癌相当。尽管如此，目前还没有适当的筛查计划来早期检测肝纤维化（肝硬化的前兆）。在这个视角中，我们利用结直肠癌和肺癌筛查的见解来探索未来肝纤维化筛查举措的好处、挑战、实施策略和途径。存在多种用于早期识别肝纤维化的非侵入性方法和转诊途径，但除了准确检测之外，筛查计划还必须具有成本效益，并通过降低肝脏相关死亡率来证明其益处。需要随机对照试验来证实这一点。未来的随机筛查试验不仅应该评估筛查测试，还应该评估用于阻止通过筛查确定的个体疾病进展的干预措施。