The Changing Global Epidemiology of Hepatocellular Carcinoma

HCC has been steadily increasing in incidence and is among the leading causes of morbidity and mortality in the United States and the world. Previously limited to developing countries, it is now impacting the northern and western hemispheres. With the burden of HCC expected to increase in the coming years, prevention of HCC through the modification of risk factors will be imperative. Owing to the current epidemic of metabolic syndrome, the population affected by NAFLD and NASH continues to increase and now comprises a significant portion with HCC. The majority of efforts to prevent the progression from NASH to cirrhosis and HCC at this time focus on improving the metabolic syndrome and obesity, with an emphasis on dietary and lifestyle changes. As clinical trials for targeted pharmacologic therapy for the treatment of NASH are underway, there is promise that the future will bring medical therapies aimed to prevent fibrosis and decrease the risk for HCC development. The WHO goal of obtaining universal HBV vaccination by 2016 has led to a global effort to improve vaccination efforts, prevent MTCT and implement linkage to care to avoid the development of HCC in addition to cirrhosis. Finally, the use of highly effective DAA therapies to reduce the burden of chronic HCV has decreased but not eliminated the risk of subsequent HCC development. Ongoing HCC risk factor identification and global attention to the prevention and treatment of chronic liver diseases will be critical to slowing the incidence of