Hepatitis Viruses Drive Three-Quarters of Global Liver Cancer Cases

Hepatocellular carcinoma (HCC) is one of the deadliest and fastest-rising cancers globally, yet the majority of cases are preventable. Understanding exactly how much of this burden stems from identifiable, treatable causes — particularly hepatitis B (HBV) and hepatitis C (HCV) — is essential for directing prevention resources effectively.

Researchers from the International Agency for Research on Cancer conducted a systematic review and meta-analysis covering publications from October 2014 through December 2023. They analyzed 857 eligible studies from 81 countries or territories, pooling prevalence data for both HBV and HCV among HCC patients to calculate attributable fractions and age-standardized incidence rates at national, regional, and global levels.

The results are striking. Globally, HBV accounts for 52% of HCC cases — approximately 345,000 cases in 2022 — while HCV accounts for 21%, or roughly 134,000 cases. Together, these two viruses are responsible for nearly three-quarters of worldwide liver cancer. HBV's footprint is largest in Eastern Asia, where it drives 70% of HCC, with Mongolia and Vietnam showing incidence rates exceeding 10 per 100,000. HCV dominates in Northern Africa, particularly Egypt, where it causes 77% of cases. Notably, HBV-related HCC patients are younger than those with HCV-related disease, suggesting earlier viral acquisition and prolonged carcinogenic exposure. In Europe and South America, metabolic dysfunction-associated steatotic liver disease and alcohol emerge as growing contributors, exceeding 30% in some nations.

For clinicians and public health practitioners, the implications are profound. Effective HBV vaccines and curative HCV antivirals already exist. Achieving high vaccination coverage and treating HCV-infected individuals at scale could prevent the vast majority of global HCC cases. Screening programs should be prioritized in high-burden regions, and Western countries must increasingly address metabolic and alcohol-related risk. This evidence base directly supports WHO hepatitis elimination targets.