The epidemiology of hepatocellular carcinoma (HCC) is changing over time, with decreases in viral hepatitis-related cases and increases in the proportion attributed to non-viral etiologies, including non-alcoholic fatty liver disease (NAFLD). Historically, HCC risk and targeting of surveillance programs were largely restricted to patients with cirrhosis, outside of hepatitis B infection. However, this paradigm was challenged by studies that demonstrated up to one-third of HCC in the setting of NAFLD occur in the absence of cirrhosis, raising the question if surveillance programs should be expanded to non-cirrhotic NAFLD.