Digestive Diseases and Sciences

, Volume 36, Issue 7, pp 962–972 | Cite as

Hepatocellular carcinoma

A worldwide problem and the major risk factors
  • Rosa Giovanna Simonetti
  • Calogero Cammà
  • Felice Fiorello
  • Flavia Politi
  • Gennaro D'Amico
  • Luigi Pagliaro
Conference Report


Male sex, age, cirrhosis, and HBsAg are the major risk factors for hepatocellular carcinoma (HCC). The geographic distribution of HCC is highly uneven, such that three distinct incidence areas are recognized. To clarify the reason(s) for this geographic variability of HCC, the risk factors in earch incidence area were assessed. In parallel with the geographic distribution of HCC, HBsAg prevalence was highest in both HCC patients and in general population in Africa and Asia, where mothers of HCC patients are frequently HBsAg-positive, suggesting that hepatitis B virus hyperendemicity and perinatal infection account for the high HCC incidence in these areas. Cirrhosis, which is found on autopsy in 80% of the cases of HCC patients worldwide, is the most prevalent risk factor for HCC in areas where hepatitis B virus infection is less common. However, HBsAg carriage adds to the HCC risk carried by cirrhosis and explains the higher incidence of HCC in cirrhotics from Africa and Asia as well as elsewhere. Available data suggest that chronic HCV infection is a risk factor for cirrhosis and HCC. HBV vaccination should decrease HCC incidence rates worldwide; however, HCC prevention in regions where HBsAg carriage is infrequent may also require prevention of the other causes of cirrhosis in order for HCC rates to decline.

Key Words

HCC risk factors geographic distribution box plot 


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Copyright information

© Plenum Publishing Corporation 1991

Authors and Affiliations

  • Rosa Giovanna Simonetti
    • 1
  • Calogero Cammà
    • 1
  • Felice Fiorello
    • 1
  • Flavia Politi
    • 1
  • Gennaro D'Amico
    • 1
  • Luigi Pagliaro
    • 1
  1. 1.Divisione di Medicina Generale, and Clinica Medica “R,”Ospedale “V. CERVELLO”PalermoItaly

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