{
  "abstract": "Hepatocellular carcinoma (HCC) surveillance has been a major component of hepatology outpatient management for over 40 years. Surveillance aims to increase life span following HCC diagnosis in those to whom it is applied, yet it remains chronically underused and inequitably delivered. In this article, we discuss the root causes of this underuse/inequity and evaluate current initiatives to improve surveillance through a root cause ‘lens’. Accordingly, five major root causes were identified: (1) weak evidence base, (2) onerous resource burden, (3) lack of clinical accountability; (4) imperfect surveillance test; and (5) undiagnosed chronic liver disease.Recent investments from National Health Service England, research funders and industry are changing the surveillance landscape. However, we argue that some root causes are still not being adequately confronted (eg, weak evidence base, onerous resource burden and limited population oversight). We identify latent opportunities to intervene more comprehensively at the root cause level, including by exploiting linked health data, facilitating risk-based surveillance and strengthening the evidence base in key areas.",
  "authors": [
    {
      "affiliations": [
        "School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK",
        "Lifespan and Population Health, University of Nottingham, Nottingham, UK"
      ],
      "name": "Hamish Innes"
    },
    {
      "affiliations": [
        "Department of Translational Medicine, University of Liverpool, Liverpool, UK",
        "Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK"
      ],
      "name": "Timothy J S Cross"
    },
    {
      "affiliations": [
        "Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK"
      ],
      "name": "Philip Johnson"
    },
    {
      "affiliations": [
        "Cancer Research UK Scotland Institute, Glasgow, UK",
        "Cancer Research UK Scotland Centre, Glasgow, UK"
      ],
      "name": "Denise Calder"
    },
    {
      "affiliations": [
        "Cancer Research UK Scotland Institute, Glasgow, UK",
        "University of Edinburgh, Institue for Regeneration and Repair, Edinburgh, UK"
      ],
      "name": "Thomas G Bird"
    }
  ],
  "title": "Surveillance for hepatocellular carcinoma in the UK: a root cause analysis towards delivering future improvements",
  "uid": "097012b9-8b67-5518-aa11-52a4029d5195"
}