Supporting early detection of liver cancer in Australia

By Inosha Alwis, AusHSI PhD Scholar

Since the early days of my medical training, interactions with patients have often made me realise how strongly our health behaviours and choices are shaped by society, culture and the economy. This has sparked a passion for social sciences, alongside my interest in clinical sciences. Working as a medical officer in Sri Lanka, I saw first-hand how hospital treatments were often too late to save the lives of some patients, especially those with non-communicable diseases (NCDs) like cancers.

These experiences prompted my transition from clinical medicine into public health. Since 2021, I have been working as a junior lecturer and researcher at the Department of Community Medicine, University of Peradeniya. My masters thesis explored the disease burden and out-of-pocket costs for outpatients in Sri Lanka, which led to a research interest in applying health economics to NCD prevention and my current PhD on hepatocellular carcinoma surveillance.

Hepatocellular carcinoma (HCC) is the most common type of cancer that occurs in the liver. It has become the fastest-rising cause of cancer mortality in Australia, and detecting HCC early is very important. Surveillance involves carrying out regular check-ups for people at higher risk for HCC, such as those with cirrhosis or chronic Hepatitis B.

While evidence shows that surveillance can improve survival through earlier detection and treatment, the standard ultrasound test has limitations which can affect accuracy. Newer methods, such as shorter magnetic resonance imaging (MRI) scans and biomarker panels, are shown to be better at finding cancer early. Despite the availability of surveillance tests in Australia, uptake is variable and, in some areas, only a small proportion of at-risk patients are undergoing regular surveillance. Through my doctoral work, I aim to investigate two key factors that could improve this: patient preferences and cost-effectiveness.

I began my PhD by reviewing global preferences of patients and healthcare providers around HCC surveillance. This work identified important gaps, including limited evidence on patient preferences and underrepresentation of Asia-Pacific populations. I will be presenting these findings at the upcoming Australian Gastroenterology Week 2026 Conference in Perth.

The next exciting stage of my PhD will involve conducting a discrete choice experiment (DCE), a type of preference survey. This will help understand HCC surveillance preferences among at-risk patients in the Sunshine Coast Hospital and Health Service region in Queensland. My final study will use economic modelling to see if new, more accurate, surveillance methods are cost-effective compared to the standard ultrasound scans that are currently offered in Australia.

This research will generate policy-relevant evidence at a critical time, as Australia looks to launch a national HCC surveillance program. I am also collaborating with the Liver Foundation, a leading non-profit organisation in this space, to encourage early advocacy and consumer engagement.

In planning the project, the encouragement and support I have received from my supervisory panel and from everyone at the Australian Centre for Health Services Innovation and QUT have been amazing. Our partnership with Prof. James O’Beirne at the Sunshine Coast University Hospital, who is a leading researcher in this field, has also been a great strength.

I am excited to be on this research journey that may ultimately help design a cost-effective, patient-centred HCC surveillance program with the potential to save lives at risk in Australia. I also look forward to applying the knowledge and skills I gain in cancer surveillance and health economics to real-world decision-making on NCD prevention in Sri Lanka.