A Decade of Cholangiocarcinoma Screening and Care Program (CASCAP): Achievements and Challenges

Cholangiocarcinoma (CCA) remains a major public health challenge in Thailand, where Opisthorchis viverrini (OV) infection contributes substantially to its high incidence. Launched in 2013, the Cholangiocarcinoma Screening and Care Program (CASCAP) integrates liver-fluke control, ultrasonography-based screening, referral, treatment, and longitudinal follow-up through the Isan Cohort digital platform. During 2013–25, more than 906,000 individuals underwent ultrasonography screening and over 4 million records were integrated. More than 80% of screen-detected CCA cases were diagnosed at stages 0–II, compared with approximately 20% of symptomatic walk-in cases, accompanied by higher resectability and improved survival. Teleconsultation ultrasonography, artificial intelligence-assisted image analysis, and urine-based OV antigen testing have further strengthened screening and diagnosis. Persistent transmission, long disease latency, diagnostic limitations, and health-system constraints remain challenges. Sustained impact will require stronger national health-system integration, improved prevention and treatment, biomarker development and validation, and international collaboration to reduce CCA mortality and advance towards a fluke-free future.