Objective  To evaluate the compliance of participants to recommended liver cancer screening and to assess the incidence of subsequent liver cancer.

  Methods  Cancer Research Institute of Zhongshan City launched liver cancer screening in 2012, in agreement with the requirements of the Committee on Early Diagnosis and Treatment of Cancer Foundation in China. Enzyme-linked immunosorbent assay (ELISA) for hepatitis B surface antigen (HBsAg) was the initial screening test performed in the population. We proposed that subjects positive for HBsAg undergo biannual screening using serum alpha-fetoprotein (AFP) tests and ultrasonography. All subjects were followed up till the end of December 2017. The prevalence of liver cancer and patients' compliance were statistically analyzed.

  Results  1) We identified 2, 882 HBsAg-positive participants among the total of 19, 386 participants in 2012. The HBsAg positivity rate was 14.9%. 13 patients with liver cancer, identified in the preliminary screening, were excluded from the study, and the remaining 2, 869 participants were followed-up. During four consecutive years (2014-2017), the compliance to AFP testing (58.9%) was higher than that (57.2%) to ultrasonography (P < 0.01). The compliance to AFP and ultrasonography in the first half of the year were 62.8% and 62.2%, respectively, and the compliance in the latter half of the year were 55.0% and 52.1%, respectively. The compliance in the first half of the year was higher than that in the latter half of the year (P < 0.01). The compliance to screening was higher in women than in men. The compliance was the lowest in men aged 35-44 years. 2) The incidence of liver cancer in HBsAg-positive participants and HBsAg-negative participants were 363.5/10⁵ and 20.9/10⁵, respectively. The former was higher than the latter (P < 0.05). The rate of early diagnosis (57.9% vs. 47.4%) did not differ significantly between the two groups (P>0.05). 3) The liver cancer patients in the high compliance to ultrasonography screening and HBsAg-positive groups had better survival rates than those in the low-compliance and HBsAgnegative groups, respectively (P < 0.05).

  Conclusion  The rates of compliance to screening and the early diagnosis rate of liver cancer are low in HBsAg-positive participants. The liver cancer survival is relatively good in the cohort with high ultrasonography compliance. Improving the compliance of HBsAg-positive population is one of the important ways to increase the early diagnosis rate and survival rate of liver cancer.