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Epidemiology and etiologic associations of hepatocellular carcinoma

Authors
Jonathan M Schwartz, MD
Robert L Carithers, Jr, MD
Section Editors
Kenneth K Tanabe, MD
Adrian M Di Bisceglie, MD
Deputy Editors
Anne C Travis, MD, MSc, FACG, AGAF
Diane MF Savarese, MD

INTRODUCTION

Hepatocellular carcinoma (HCC) results in between 250,000 and one million deaths globally per annum [1-4]. HCC has unique geographic, sex, and age distributions that are likely determined by specific etiologic factors.

This topic will review the epidemiology and etiologic associations of HCC. Surveillance recommendations, clinical manifestations, diagnosis, and management of HCC are discussed separately. (See "Prevention of hepatocellular carcinoma and recommendations for surveillance in adults with chronic liver disease" and "Clinical features and diagnosis of primary hepatocellular carcinoma" and "Staging and prognostic factors in hepatocellular carcinoma" and "Overview of treatment approaches for hepatocellular carcinoma".)

EPIDEMIOLOGY

Liver cancer in adult men is the fifth most frequently diagnosed cancer worldwide, and is the second leading cause of cancer-related death in the world [5]. In adult women, it is the seventh most commonly diagnosed cancer and the sixth leading cause of cancer death. In the United States (US), the annual incidence of hepatocellular carcinoma (HCC) was at least 6 per 100,000 in 2010 [6]. Among US children, the annual incidence was 0.05 cases per 100,000 in 2009 [7].

The number of deaths per year in HCC is virtually identical to the incidence throughout the world, underscoring the high case fatality rate of this aggressive disease [5]. Almost 80 percent of cases are due to underlying chronic hepatitis B and C virus infection [8].

Time trends — Liver cancer incidence rates and death rates are increasing in many parts of the world, including North America, Latin America, and central Europe [9-11]. In an analysis of data reported to the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Database of the National Cancer institute in the US, liver cancer incidence rates increased by 3.1 percent per year from 2008 to 2012 [10]. The incidence was threefold higher in men compared with women (11.5 versus 3.9 per 100,000). Liver cancer incidence rates increased during this time period among non-Hispanic whites, non-Hispanic blacks, and American Indian/Alaska Natives, but they decreased among non-Hispanic Asians and Pacific Islanders (a trend possibly related to the increasingly widespread vaccination of children against hepatitis B viral infection, the dominant HCC-related virus among Asian/Pacific Islanders). In contrast to the declining death rates seen for all other common cancers (such as lung, breast, and prostate cancers), death rates from liver cancer in men increased by 2.8 percent per year and for women it increased by 3.4 percent per year.  

                                 

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