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27-08-2016 | Hepatocellular carcinoma | Article

1. Epidemiology of Hepatocellular Carcinoma

Authors: Donna L. White, Fasiha Kanwal, Li Jiao, Hashem B. El-Serag

Publisher: Springer International Publishing


Liver cancer is the second leading cause of cancer-related mortality resulting in 745,000 deaths annually worldwide. It is overwhelmingly manifest as hepatocellular carcinoma (HCC) arising in middle-aged and older adults. It is also largely a preventable disease. Globally, most cases are related to chronic hepatitis B virus (HBV) infection, and occur in sub-Saharan Africa and Eastern Asia (except Japan). In contrast, hepatitis C virus (HCV) is the leading cause in North America and Western Europe. Recent rapid increases in HCC rates have been observed in several Western populations (particularly in the U.S.) and largely parallel rapidly increasing rates of obesity and diabetes. Striking geographic and racial variations in HCC risk are also evident and likely predominantly due to known differences in the prevalence of major risk factors like HBV and HCV infections. Other established risk factors for HCC include older age, male sex, heavy alcohol intake, aflatoxin exposure, iron overload related to hemochromatosis, and possibly tobacco smoking. The role of diet is largely unknown; however, higher levels of caffeinated coffee consumption are consistently associated with decreased HCC risk across diverse viral and nonviral disease etiologies and populations. Host inherited genetic variation is also being increasingly examined in association with HCC risk, but definitive data are largely lacking. Overall, most HCC risk factors operate by promoting the development of cirrhosis which is primary precursor lesion in most cases. Once cirrhosis is established, the annual risk of HCC ranges between 1 and 7 % thereafter, with particularly increased risk of progression in males with chronic HCV infection. This review discusses in detail the epidemiology of liver cancer, and particularly of HCC, from a global perspective.

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