[Prevention of Cirrhosis is the Best Measure Against Hepatocellular Cancer]

The prevalence of adult cirrhosis in Western countries is estimated to be about 3-5 per cent. Hepatocellular carcinoma (HCC), the predominant type of primary liver cancer, is associated with cirrhosis in a majority of cases. The estimated annual incidence of cancer associated with cirrhosis is 1-11 per cent. All cirrhosis may be complicated by cancer, but the cancer risk is reported to be highest in cases of hepatitis B (HBV) or C (HCV) infection, or haemochromatosis. In two Swedish studies, comprising a total of 605 patients with HCC, cirrhosis was present in about 70 per cent. The most common causes of cirrhosis were alcohol abuse and chronic HCV infection, and there was not a single case of chronic HBV infection. Most patients presented with cancer but no history of cirrhosis. In HCC, prognosis is usually very poor, and the results of screening for HCC in cirrhosis patients have been disappointing. Thus, prevention of cirrhosis (e.g., by reducing alcohol consumption), treatment of chronic HCV infection and, in certain cases, vaccination against HBV, is an approach likely to have the greatest impact on the incidence of HCC.