The epidemiology of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and the second most common cause of death from cancer worldwide. The leading risk factor for HCC is cirrhosis due to chronic hepatitis B and hepatitis C. The incidence of HCC differs greatly according to the geographic area. Regions with the highest incidence rates of liver cancer include Eastern and Southeastern Asia as well as Northern and Western Africa, which are endemic for hepatitis B virus infection. In most developed countries, the incidence of HCC is at low (Northern Europe) or intermediate (Southern Europe and Northern America) levels. In Western countries, Egypt and Japan hepatitis C virus infection is the main risk factor for HCC. However, upcoming risk factors include obesity, diabetes and nonalcoholic fatty liver disease. Considering that these factors are rapidly increasing in prevalence, they might account for a growing proportion of HCC cases in the future. In this chapter, we review the key aspects of HCC epidemiology, with a focus on the incidence and mortality rates in Western countries.