 Chronic liver disease is a silent killer. Among the millions who die from the disease each year, many can go as long as 20 years without knowing anything is wrong. By then, when cirrhosis has already set in, it's often too late. But according to researchers from Europe, it doesn't have to be this way. They're embarking on a monumental project they've dubbed, liver screen. Using cutting-edge technology, their mission is to devise and evaluate a screening strategy for detecting chronic liver disease early enough to take action. Aiming to enroll 30,000 subjects from the general population across eight countries, the project is decidedly ambitious. But if successful, it could transform the lives of millions of people across the globe. The study will focus on one major sign of liver disease in particular, fibrosis. Excessive alcohol, obesity, type 2 diabetes, and metabolic syndrome create fibrous scars as the liver tries to repair damage caused by overwork. The danger is that fibrosis itself causes no symptoms. Often, only when fibrosis has advanced to cirrhosis do patients report to the clinic. But fibrogenesis is a dynamic process. Scar fibers continuously form and fall apart. That means that fibrosis is actually reversible, at least in its early stages. So timely detection offers the possibility of reversal through treatment or lifestyle modification. Unfortunately, current methods for diagnosing fibrosis are lacking. Liver biopsy, the gold standard approach, is invasive, painful, and costly. Ultrasound produces inconclusive results at early stages, and biomarkers such as transaminase levels can be deceptive, registering normal in patients with advanced liver disease. Instead, the international team plans to use a device called Fibroscan. Fibroscan operates on the principle that scar tissue is stiffer than healthy tissue. By beaming a mixture of high and low frequency waves through the liver and reading their bounce back, Fibroscan calculates the extent of fibrosis, and it's fast and easy to use. Fibroscan can be performed by nurses or physicians after a short training and can produce results in 5 minutes. After detecting liver disease early in asymptomatic subjects, the liver screen team will link Fibroscan to blood tests and genetic results obtained from the same subjects. That could help researchers detect indirect signals of fibrosis and identify subjects with susceptibility of progression. Ultimately, liver screen will assemble a list of factors that identify patients as high risk for cirrhosis or disease progression, which could lead to tremendous savings in cost and time for healthcare systems and patients alike. With obesity and alcohol consumption on the rise, the results of the liver screen project could prove timely. Understanding what to look for in the clinic would aid doctors in the struggle to spot and treat liver disease before it's too late.