The epidemiology of hepatocellular carcinoma (HCC) is characterized by marked differences between genders, ethnic groups, and geographic regions. These variations are explained by the nature, frequency, and time of acquisition of the major risk factors for cirrhosis--namely hepatitis B virus, hepatitis C virus (HCV), and alcoholic cirrhosis. The incidence and mortality of HCC has been rising in the US over the last two decades and is progressively affecting younger persons. The evidence indicates that HCV infection is responsible for the current trends.