Is mailed outreach and patient navigation a perfect solution to improve HCC screening?

Hepatocellular carcinoma (HCC) is a significant global health problem, and its incidence is expected to exceed 1 million new HCC annually by 2025.1 The reported 3-year survival rate for advanced-stage HCC is less than 17%, while 70% of patients diagnosed with early-stage HCC can achieve 5-year survival.2 Despite well-established guidelines and the clear benefits of early detection, the meta-analysis results (29 papers, 1 18 799 patients) showed that only 24% of individuals at risk for developing HCC were screened.3 Efforts to surmount barriers at patient, provider and healthcare levels have shown a minimal screening rate increase over time.3 4 One of the reasons for the disappointing results might be the fact that authors focused on individual barriers, rather than considering the screening failure the result of the interplay of different factors. Additionally, the published studies have the following limitations, detailed reasons for screening failure are missing, the majority of the studies are done in single centre and the results generalisability is not possible, the definition of HCC screening differs per study, short follow-up periods.2 3 Singal et al have to be commended for their work published recently in Gut .5 The authors conducted a multicentre (three centres) randomised clinical trial between April …