To the Editor: Liver cancer (LC) is one of the most commonly diagnosed cancers and the leading cause of cancer mortality in the world, with approximately 905,677 new cases and 830,180 deaths in 2020. [1] Clearly, the huge burden exerted by LC highlights the need to effectively decrease the incidence and mortality of LC.Unfortunately, survival rates of LC have been maintained at a low level to date. A recent meta-analysis showed that the age-standardized 5-year LC survival rate in China was 10.1% in 2003 to 2005 and 12.1% in 2012 to 2015. [2] The poor prognosis of LC may be partly attributed to the advanced stages once diagnosed for most patients, suggesting that early detection, early diagnosed, and early treatment of LC are warranted. [3] A population-based cancer screening program targeting LC in high-risk areas of rural China was initiated in 2007, in which combinations of B-scan ultrasound and serum alpha-fetoprotein (AFP) were recommended for screening high-risk populations. A study in Shanghai had revealed that this screening program was effective in reducing the mortality and burden of LC. [3] However, available evidence indicated that the compliance of LC screening programs in the Chinese population was unsatisfactory. Thus, it is necessary to explore associated factors for participation rates (PRs) in the population-based LC screening program. Some studies found that lower cancer prevention awareness was associated with lower PRs of cancer screening programs. [4][5][6] However, whether cancer prevention awareness could influence PRs of LC screening program remains unknown in China.