Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice
Open accessAbstract
The epidemiology of hepatocellular carcinoma (HCC) is characterized by dynamic temporal trends, several major established (i.e., HCV, HBV, alcohol) and emerging (i.e., diabetes, obesity, NAFLD) risk factors. Epidemiologic studies and clinical trials have identified additional demographic, clinical, pharmacological, genetic and life style factors that further affect or modify the likelihood of HCC and can be used in clinical practice to identify at-risk patients (i.e., risk stratification or prognostic algorithms) that can be targeted for prevention and early detection programs. These studies have also paved the way toward several well established preventive measures including HBV vaccination, HBV treatment, HCV treatment and HCC surveillance, and potential chemoprevention using statins, metformin or coffee. However, the effectiveness of HCC prevention in clinical practice and at the population level has lagged behind due to patient, provider, system, and societal factors. The Quality in the Continuum of Cancer Care model provides a framework for evaluating the HCC prevention processes, including potential failures that create a gap between efficacy and effectiveness.
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The underlying liver disease type carries a specific hepatocellular carcinoma risk in cirrhosis, with chronic hepatitis B or C and haemochromatosis at relatively high risk and autoimmune hepatitis or alcoholic liver disease at relatively low risk.
“However, additional factors are involved and each type of underlying liver disease entails a specific risk for the development of HCC in cirrhosis; diseases such as chronic hepatitis B and C or haemochromatosis entail a relatively high risk and diseases such as autoimmune hepatitis or ALD a relatively low risk38–40.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [40]
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Elmunzer, B. J., Singal, A. G., Sussman, J. B., Deshpande, A. R., Sussman, D. A., Conte, M. L., Dwamena, B. A., Rogers, M. A. M., Schoenfeld, P., Inadomi, J. M., et al. (2015) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2014.10.033 · Cited by 63 · see citing works
Self-citationSuboptimal Surveillance for and Knowledge of Hepatocellular Carcinoma Among Primary Care Providers
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Improving Hepatocellular Carcinoma Screening: Applying Lessons From Colorectal Cancer Screening
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Whither (Wither?) the Ultrasound Specialist?
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Efficacy, effectiveness, and comparative effectiveness in liver disease
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Self-citationScreening Process Failures for Hepatocellular Carcinoma
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Self-citationα-Fetoprotein in Hepatocellular Carcinoma Surveillance: Mend It but Do Not End It
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Self-citationHepatitis C Virus Treatment: The Unyielding Chasm Between Efficacy and Effectiveness
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Self-citationSurveillance for Hepatocellular Carcinoma: Can We Focus on the Mission?
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Self-citationDiagnostic Imaging and Biopsy Use Among Elderly Medicare Beneficiaries With Hepatocellular Carcinoma
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Statins for chemoprevention of hepatocellular carcinoma: assessing the evidence
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Self-citation
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The Role of Cancer-Associated Fibroblasts and Fibrosis in Liver Cancer
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Risk factors and prevention of hepatocellular carcinoma in the era of precision medicine
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Inflammation-induced IgA+ cells dismantle anti-liver cancer immunity
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Nonalcoholic fatty liver disease and chronic vascular complications of diabetes mellitus
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Hepatic Stellate Cell-Macrophage Crosstalk in Liver Fibrosis and Carcinogenesis
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Harnessing big ‘omics’ data and AI for drug discovery in hepatocellular carcinoma
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Loss of protein phosphatase 2A regulatory subunit B56δ promotes spontaneous tumorigenesis in vivo
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Hughes, D. M., Berhane, S., Emily de Groot, C. A., Toyoda, H., Tada, T., Kumada, T., Satomura, S., Nishida, N., Kudo, M., Kimura, T., et al. (2021) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.04.084 · Cited by 39 · see citing works
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- Authors
- Singal, A. G., & El-Serag, H. B.
- Affiliations
- The University of Texas Southwestern Medical Center (US)
- ORCID
- Singal, Amit G.
- Venue
- Clinical Gastroenterology and Hepatology
- Publisher
- Elsevier BV
- Published
- 2015-11
- Volume
- 13
- Issue
- 12
- Pages
- 2140-2151
- ISSN
- 1542-3565 (ISSN-L)
- PMC
- PMC4618036
- OpenAlex
- W2109202667
- Cited by
- 530
- References
- 112
- Citations by year
- 2026: 13 · 2025: 21 · 2024: 41 · 2023: 45 · 2022: 40 · 2021: 68 · 2020: 69 · 2019: 61 · 2018: 64 · 2017: 54 · 2016: 51 · 2015: 3
- FWCI
- 8.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K24-04-107)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
- Health Sciences › Medicine › Otorhinolaryngology › Head and Neck Cancer Studies
- Keywords
- hepatocellular carcinoma, HCC prevention, HCC risk factors, hepatitis C virus, hepatitis B virus, alcohol, diabetes mellitus, obesity, non-alcoholic fatty liver disease, risk stratification, prognostic algorithm, hepatitis B vaccination, hepatitis C treatment, HCC surveillance, chemoprevention, statins, metformin, coffee, efficacy-effectiveness gap, early detection
- MeSH terms
- Hepatitis B, Hepatitis C, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Risk Factors, Chemoprevention, Early Detection of Cancer
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