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Geriatric Care Worldwide: Challenges and Opportunities

Robert Durkey

In terms of prevalence, hepatocellular carcinoma (HCC) is the seventh most frequent malignancy worldwide. East and Southeast Asia as well as sub-Saharan Africa are high-risk areas. Men experience rates that are at least two to three times higher than women, regardless of ethnicity or location; this sex ratio is more prominent in high-risk areas. Over the past 20 years, HCC rates in the US have climbed by 70%. Similar trends can be seen in registry data from Canada and Western Europe. In contrast, the prevalence of HCC has steadily decreased over the past 20 years in Singapore and Shanghai, China, both high-risk areas. The frequency of HCC is inversely related to socioeconomic class position among both white and black Americans. The hepatitis B virus (HBV) infection is by far the most significant risk factor for HCC in humans. According to estimates, HBV has a causal role in 80% of HCC cases worldwide. HBV is thought to be responsible for one in four instances of HCC among non-Asians in the United States, despite the low overall infection incidence. Hepatitis C virus infection is thought to have a relatively little impact on the development of HCC in Africa and Asia, despite being a significant risk factor for HCC in the United States. In portions of Asia and Africa, dietary aflatoxin exposure is a significant codeterminant of the risk of HCC. Excessive alcohol use, cigarette smoking, and female oral contraceptive use are risk factors for HCC in both Canada and the US.