Objective <p>This bibliometric study aims to comprehensively map the evolution of hepatocellular carcinoma (HCC) screening research in high-risk populations and to conduct a comparative analysis across the three major etiologies: hepatitis B virus (HBV), hepatitis C virus (HCV), and metabolic dysfunction-associated steatotic liver disease (MASLD).</p> Method <p>Publications were retrieved from the Web of Science Core Collection (inception to September 4, 2025). Bibliometric analyses were performed using VOSviewer, CiteSpace, and Excel, with etiology-specific subsets created for comparative analysis.</p> Results <p>A total of 1422 publications were analyzed. The field experienced exponential growth after 2007, with distinct trajectories: HBV research showed steady growth, HCV exhibited volatility, MASLD accelerated rapidly since 2019. The United States and China dominated contributions (53.52%). Dr. Amit G. Singal was the most prolific and influential author. Core journals were predominantly high-impact Q1 journals. Co-citation analysis reveals that the intellectual foundation is primarily built upon authoritative guidelines and seminal studies. Keyword analysis delineated three main themes: etiologies and high-risk populations, screening concepts and outcomes, and methodologies. Keyword burst analysis revealed three phases: early focus on AFP and viral etiologies; a shift toward risk stratification; and the current phase characterized by technological advances such as MRI.</p> Conclusion <p>The field of HCC screening in high-risk populations has shifted from viral to metabolic etiologies, from basic tools (AFP, ultrasound) to advanced technologies (MRI), and from universal screening toward risk stratification and personalized surveillance. Future research should focus on abbreviated MRI and the development of etiology-specific precision risk stratification tools to optimize screening strategies.</p>