Cirrhosis in patients with chronic hepatitis C increases the risk of 
hepatocellular carcinoma (HCC), and surveillance with ultrasound (US) and 
alpha-fetoprotein (AFP) is recommended. This study aimed to estimate changes in 
the HCC incidence rate (IR) over time, HCC stage and prognosis, and AFP and US 
performed in patients with hepatitis C and cirrhosis. Eligible patients were 
identified in the Danish Database for Hepatitis B and C, and data from national 
health registries and patient charts were obtained. Tumour stage was based on 
Barcelona-Clinic Liver Cancer stage, TNM classification and size and number of 
lesions combined into stages 0-3. We included 1075 patients with hepatitis C and 
cirrhosis, free of HCC and liver transplant at baseline. During 4988 person 
years (PY), 115 HCC cases were diagnosed. The HCC incidence rate increased from 
0.8/100 PY [CI95% 0.4-1.5] in 2002-2003 to 2.9/100 PY [2.4-3.4] in 2012-2013. 
One-year cumulative incidence of at least one AFP or US was 53% among all 
patients. The positive predictive value of an AFP ≥ 20 ng mL-1 was 17%. 
Twenty-three (21%) patients were diagnosed with early-stage HCC (stage 0/1) and 
84 (79%) with late stage. Median survival after HCC for early-stage HCC disease 
was 30.1 months and 7.4 months for advanced HCC (stage 2/3). The incidence rate 
of HCC increased over time among patients with hepatitis C and cirrhosis in 
Denmark. Application of AFP and US was suboptimal, and most patients were 
diagnosed with advanced HCC with a poor prognosis.