Hepatocellular carcinoma: the rising tide from east to west—a review of epidemiology, screening and tumor markers

Hepatocellular carcinoma (HCC) is no longer a disease of the Eastern hemisphere. HCC incidence has tripled in the United States in the past two decades. It is the fastest rising cause of cancer mortality in the U.S. and in parts of Western Europe. In the past the HCC epidemic was fueled by the Hepatitis B virus (HBV) seen mainly in Asia via horizontal transmission. In this decade, we are experiencing a rising tide due to the maturation of the Hepatitis C epidemic related to contaminated blood products and, more importantly, intravenous drug experimentation. As the obesity epidemic sweeps across the west the incidence of nonalcoholic fatty liver disease (NAFLD) and its inflammatory component nonalcoholic steatohepatitis (NASH) are becoming the harbinger of HCC yet to come. Worldwide, the incidence of HCC equals the mortality. Five year survival is at best 12%. These grim statistics underscore the need for earlier detection through screening resulting in initiation of early treatment that has the greatest impact on survival. An understanding of the epidemiology, risk factors and screening techniques is an essential first step in achieving this goal.