The Epidemiology of Hepatocellular Carcinoma

Abstract

Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, is relatively rare in the West, but one that is increasing in incidence rapidly and becoming a major public health problem. In the Far East and sub-Saharan Africa, the cancer is common and invariably fatal so that overall, HCC is the second most common cause of cancer-related death. The major risk factor is chronic hepatitis B virus (HBV) infection, particularly in the East, but epidemiological studies that identified this association led to immunisation programmes that have, where implemented vigorously, dramatically decreased the impact of the disease. Similarly hepatitis C virus (HCV), common in Western countries, secondary to intravenous substance abuse, is now a curable disease, and this too is leading to a decrease in incidence. However, increasing rates of obesity and diabetes mellitus have resulted in non-alcoholic fatty liver disease (NAFLD), and this is now, and for the foreseeable future, the major cause of HCC in the West. HCC illustrates how key epidemiological studies have led to prevention strategies that have, arguably, had more impact on the disease than have therapeutic approaches.