The prevalence of hepatocellular carcinoma is a public health problem. In 2024 there were approximately 30,000 deaths from liver cancer in the United States, the vast majority of them from hepatocellular carcinoma (HCC). This compares with about42,000 deaths from breast cancer and 125,000 from lung cancer, so the number is not trivial. Several causes have been identified, all of which can be modified by behavior and/or drug therapy. They are: hepatitis B and C, alcoholic liver disease, metabolic dysfunction liver disease (also called non-alcoholic steatohepatitis). The last is comingled with obesity and diabetes. Much less common causes are genetic: hereditary hemochromatosis, alpha-1 anti-trypsin deficiency and acute intermittent porphyria.
An article recently published in JAMA Open Network looks at the changing epidemiology of HCC in the State of California. The entire article is available online without copyright restrictions. Between 2010 and 2018 epidemiologists at the University of Miami and several medical schools in California examined the etiology of HCC in California. So what did they find?
Etiology of HCC varied depending on ethnic group. The highest rates were seen among Native Americans and Asians. The mix of Asians in California is diverse, including those of Chinese, Korean, Vietnamese, and Asian-Pacific Islanders . Between 2010 and 2018 the incidence of HCC from metabolic causes (MASLD, diabetes and obesity) increased. Not discussed by the authors, but clear to those working in this field, is an unmet need for testing for Hepatitis B and C among populations. Modern antiviral therapy makes the early diagnosis of those two entities important, because those diseases can be cured with drugs. HCC from hepatitis still occurs and is sadly preventable.
So what was uncovered by this study? The metabolic causes of HCC are entirely preventable but reflect the epidemic of obesity seen in the United States today. Almost all cases of HCC are preventable yet more than 30,000 people will die this year alone in the United States.