Epidemiology and natural history of hepatocellular carcinoma

Best Pract Res Clin Gastroenterol. 2005 Feb;19(1):3-23. doi: 10.1016/j.bpg.2004.10.004.


Hepatocellular carcinoma (HCC) is a major contributor to cancer incidence and mortality. There is a wide variation, however, in the global distribution of HCC. Eighty percent of the burden is borne by countries in Asia and sub-Saharan Africa. In most high-risk countries, principal risk factors include infection with hepatitis B virus and dietary exposure to aflatoxin B(1). In contrast, hepatitis C virus and alcohol consumption are more important risk factors in low-risk countries. In recent years, the incidence of HCC has decreased in some high-risk countries and increased in some low-risk countries. Reasons for both trends are not completely understood, but are likely related to public health efforts in Asia and the increase in hepatitis C virus infection in low-risk countries. Vaccination programs against hepatitis B virus will likely decrease the HCC rate even further in decades to come.

Publication types

  • Review

MeSH terms

  • Aflatoxins / adverse effects
  • Alcohol Drinking
  • Carcinoma, Hepatocellular / epidemiology*
  • Carcinoma, Hepatocellular / genetics
  • Carcinoma, Hepatocellular / therapy
  • Carcinoma, Hepatocellular / virology
  • Chemoprevention
  • Food Contamination
  • Genetic Predisposition to Disease
  • Global Health*
  • Hepatitis B / complications
  • Hepatitis C / complications
  • Humans
  • Incidence
  • Liver Cirrhosis / complications
  • Liver Neoplasms / epidemiology*
  • Liver Neoplasms / genetics
  • Liver Neoplasms / therapy
  • Liver Neoplasms / virology
  • Risk Factors


  • Aflatoxins