Most of the burden of disease (85%) is borne in developing
countries,with the highest incidence rates reported in regions where infection
with hepatitis B virus (HBV) is endemic: Southeast Asia and sub-Saharan Africa
(Fig. 1).3 Hepatocellular carcinoma rarely occurs before the age of 40 years and
reaches a peak at approximately 70 years of age. Rates of liver cancer among men are
two to four times as high as the rates among women. Hepatocellular carcinoma
related to infection with hepatitis C virus (HCV) has become the fastest-rising cause
of cancer-related death in the United States, and during the past two decades, the incidence
of hepatocellular carcinoma in the United States has tripled while the 5-year
survival rate has remained below 12%2 (Fig. 2). The greatest proportional increase
in cases of hepatocellular carcinoma has been seen among Hispanics and whites
between 45 and 60 years of age.4