Diabetes is associated with an increased risk of multiple solid organ cancers, including HCC.1–20 Several biological mechanisms are thought to underly this association: the mitogenic effects of increased circulating insulin, increased bioavailable insulin-like growth factor 1, which promotes cellular proliferation and inhibits apoptosis, and direct effects of hyperglycemia on cancer cell behavior.21–28. Here, INS is linked to hepatocellular carcinoma.