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Clin Gastroenterol Hepatol. 2015 Nov;13(12):2140-51. doi: 10.1016/j.cgh.2015.08.014. Epub 2015 Aug 15.

Hepatocellular Carcinoma From Epidemiology to Prevention: Translating Knowledge into Practice.

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Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas.
Section of Gastroenterology and Hepatology and Center (Center for Innovations in Quality, Effectiveness and Safety), Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas. Electronic address:


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.


Chemoprevention; Cirrhosis; Hepatitis B; Hepatitis C; NAFLD; Surveillance

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