Public health strategies for hepatocellular carcinoma: from risk factors to prevention and control

다국어 초록 (Multilingual Abstract)

Hepatocellular carcinoma (HCC) remains a major global health burden, ranking as one of the leading causes of cancer-related deathsworldwide. This review synthesizes current evidence on HCC epidemiology, highlighting both modifiable and non-modifiable riskfactors, including chronic hepatitis B and C virus infections, metabolic dysfunction-associated steatotic liver disease (MASLD),excessive alcohol consumption, aflatoxin exposure, and genetic susceptibility. These diverse etiologies reflect not only biologicalmechanisms but also broader social and environmental determinants of health, emphasizing the need for integrated, populationlevelpreventive strategies. Effective strategies across all levels of prevention are reviewed. Primordial and primary preventionstrategies include public health policies, health education to raise awareness, universal hepatitis B vaccination, expanded access toantiviral therapies for hepatitis B virus (HBV) and hepatitis C virus (HCV), lifestyle interventions targeting obesity and alcohol use,and environmental controls to reduce aflatoxin exposure. Secondary prevention focuses on early detection through viral hepatitisscreening and routine HCC surveillance in high-risk populations. Tertiary prevention aims to reduce morbidity and mortality throughtimely treatment and multidisciplinary care. Despite the availability of effective tools, substantial implementation gaps remainpersist. Underdiagnosis of viral hepatitis, low treatment uptake, inadequate surveillance coverage, and disparities in healthcareaccess continue to limit progress. Addressing these challenges requires a coordinated public health response grounded in healthsystem strengthening, policy innovation, and equitable access to care. A renewed public health commitment -integrating prevention,early diagnosis, and continuity of care- is essential to reduce the global burden of HCC and bridge the gap between knowledge andaction.