ideasIdea
Cure hepatitis C in prisons and drug services, and enrol the cured in liver cancer surveillance
Hepatitis C is now curable in weeks. Testing and treating where it is concentrated, and keeping those with scarring in surveillance afterwards, would cut liver cancer.
Direct-acting antivirals cure over 95% but HCC risk persists in those with advanced fibrosis. Propose opt-out testing and immediate treatment in prisons and needle services, with automatic enrolment of F3/F4 patients into HCC surveillance, blood-based where possible.
Hypothesis
Opt-out test-and-treat with surveillance linkage reduces HCC incidence and late-stage HCC among people who inject drugs by at least 40% within a decade.
Rationale
Elimination programmes in Egypt, Georgia and Australia show feasibility; the surveillance step is usually missing.
What would test it
Run a regional programme with registry evaluation.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Medium ($1M to $50M)
Years to first evidence
6
Bottlenecks it attacks
- Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.