Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis
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Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer mortality worldwide. Incidence rates of liver cancer vary widely between geographic regions and are highest in Eastern Asia and sub-Saharan Africa. In the United States, the incidence of HCC has increased since the 1980s. HCC detection at an early stage through surveillance and curative therapy has considerably improved the 5-year survival. Therefore, medical societies advocate systematic screening and surveillance of target populations at particularly high risk for developing HCC to facilitate early-stage detection. Risk factors for HCC include cirrhosis, chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV), excess alcohol consumption, non-alcoholic fatty liver disease, family history of HCC, obesity, type 2 diabetes mellitus, and smoking. Medical societies utilize risk estimates to define target patient populations in which imaging surveillance is recommended (risk above threshold) or in which the benefits of surveillance are uncertain (risk unknown or below threshold). All medical societies currently recommend screening and surveillance in patients with cirrhosis and subsets of patients with chronic HBV; some societies also include patients with stage 3 fibrosis due to HCV as well as additional groups. Thus, target population definitions vary between regions, reflecting cultural, demographic, economic, healthcare priority, and biological differences. The Liver Imaging Reporting and Data System (LI-RADS) defines different patient populations for surveillance and for diagnosis and staging. We also discuss general trends pertaining to geographic region, age, gender, ethnicity, impact of surveillance on survival, mortality, and future trends.
Key wordsReview article Hepatocellular carcinoma Epidemiology Risk factors Prevalence Incidence
American Association for the Study of Liver Diseases
Asian Pacific Association for the Study of the Liver
European Association for the Study of the Liver-European Organization for Research and Treatment of Cancer
Hepatitis B virus
Hepatitis C virus
Japan Society of Hepatology
Korean Liver Cancer Study Group and the National Cancer Center
Liver Imaging Reporting and Data System
Non-alcoholic fatty liver disease
World Health Organization
Compliance with Ethical Standards
This work was supported by a clinical research scholarship by the Fonds de recherche du Québec—Santé and Fondation de l’association des radiologistes du Québec (Career Award #26993) to An Tang.
Conflict of Interest
An Tang, Victoria Chernyak, Aya Kamaya and Claude B. Sirlin are members of the LI-RADS Steering Committee. Oussama Hallouch declares that he has no conflict of interest. Aya Kamaya receives royalties from Elsevier/Amirsys. Claude B. Sirlin has industry research grants from Bayer, Guerbet, Siemens, GE, Philips, Supersonic, and Arterys and consulting and service agreements with Alexion, AstraZeneca, Bioclinica, BMS, Bracco, Celgene, Fibrogen, Galmed, Genentech, Genzyme, Gilead, Icon, Intercept, Isis, Janssen, NuSirt, Perspectum, Pfizer, Profil, Sanofi, Shire, Synageva, Tobira, Takeda, and Virtual Scopics.
This article does not contain any studies with human participants performed by any of the authors.
No IRB approval was required for this review article.
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