Worldwide, HCC is the sixth most common cause of cancer and the second leading cause of cancer-related death. The global incidence of HCC varies according to the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Overall, 44% of HCC cases worldwide are attributable to chronic HBV infection, with the majority of cases occurring in Asia.[1]Baecker A, Liu X, La Vecchia C, et al. Worldwide incidence of hepatocellular carcinoma cases attributable to major risk factors. Eur J Cancer Prev. 2018 May;27(3):205-12.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876122
http://www.ncbi.nlm.nih.gov/pubmed/29489473?tool=bestpractice.com
In the US, liver cancer incidence more than tripled in the past four decades; the incidence has stabilised in men since 2015 but continues to increase in women by 2% every year.[2]American Cancer Society. Cancer facts and figures. 2024 [internet publication].
https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/2024-cancer-facts-figures.html
HCC is the most common type of liver cancer and accounts for 75% to 86% of cases.[3]Singal AG, Llovet JM, Yarchoan M, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023 Dec 1;78(6):1922-65.
https://journals.lww.com/hep/fulltext/2023/12000/aasld_practice_guidance_on_prevention,_diagnosis,.27.aspx
http://www.ncbi.nlm.nih.gov/pubmed/37199193?tool=bestpractice.com
The age distribution of HCC in the US has also shifted toward younger ages, with a proportional increase in those aged 45-60 years.[4]El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go? Hepatology. 2014 Nov;60(5):1767-75.
https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.27222
http://www.ncbi.nlm.nih.gov/pubmed/24839253?tool=bestpractice.com
In 2012, the age-adjusted incidence of HCC in the US was 6.7 per 100,000.[5]White DL, Thrift AP, Kanwal F, et al. Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through 2012. Gastroenterology. 2017 Mar;152(4):812-20;e5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5346030
http://www.ncbi.nlm.nih.gov/pubmed/27889576?tool=bestpractice.com
In the EU, in 2012, the estimated incidence rate was 10.0 per 100,000 in men and 3.3 per 100,000 in women.[6]Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29 (suppl 4):iv238-55.
https://www.annalsofoncology.org/article/S0923-7534(19)31711-9/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/30285213?tool=bestpractice.com
[7]Vogel A, Martinelli E; ESMO Guidelines Committee. Updated treatment recommendations for hepatocellular carcinoma (HCC) from the ESMO Clinical Practice Guidelines. Ann Oncol. 2021 Jun;32(6):801-5.
https://www.annalsofoncology.org/article/S0923-7534(21)00154-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/33716105?tool=bestpractice.com
The increased incidence in men may be due to sex-specific prevalence of risk factors, including the trophic effects of androgens.[8]Tanaka K, Sakai H, Hashizume M, et al. Serum testosterone:estradiol ratio and the development of hepatocellular carcinoma among male cirrhotic patients. Cancer Res. 2000 Sep 15;60(18):5106-10.
https://aacrjournals.org/cancerres/article/60/18/5106/506692/Serum-Testosterone-Estradiol-Ratio-and-the
http://www.ncbi.nlm.nih.gov/pubmed/11016636?tool=bestpractice.com
[9]Wang SH, Yeh SH, Lin WH, et al. Identification of androgen response elements in the enhancer I of hepatitis B virus: a mechanism for sex disparity in chronic hepatitis B. Hepatology. 2009 Nov;50(5):1392-402.
https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.23163
http://www.ncbi.nlm.nih.gov/pubmed/19670412?tool=bestpractice.com
In the UK, HCC is the cause of death in over 5000 patients a year.[10]Cancer Research UK. Statistics by cancer type: liver cancer. 2019 [internet publication].
https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/liver-cancer
Mean age at diagnosis of HCC is 60 years in the US and Europe, 50-60 years in Asia, and 46 years in Africa.[4]El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go? Hepatology. 2014 Nov;60(5):1767-75.
https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.27222
http://www.ncbi.nlm.nih.gov/pubmed/24839253?tool=bestpractice.com
[11]El-Serag HB. Hepatocellular carcinoma: an epidemiologic view. J Clin Gastroenterol. 2002 Nov-Dec;35(5 suppl 2):S72-8.
http://www.ncbi.nlm.nih.gov/pubmed/12394209?tool=bestpractice.com
[12]Yang JD, Mohamed EA, Aziz AO, et al. Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium. Lancet Gastroenterol Hepatol. 2017 Feb;2(2):103-11.
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(16)30161-3/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/28403980?tool=bestpractice.com