Disparities in Diagnosis, Management, and Outcomes of Hepatocellular Carcinoma: A Review of Global and Sociodemographic Factors

Hepatocellular carcinoma (HCC), the most common primary liver cancer, is a leading cause of cancer-related death. There are significant disparities in risk, receipt of screening for HCC, stage at diagnosis, receipt of treatment and survival. Differential HCC risk for HCC is driven by variation in the etiology of underlying liver disease, which varies by race, ethnicity, gender, and geographic location. Sociocultural and structural forces influence access to health care, which may limit adherence to guideline-recommended HCC screening intervals. Black race and uninsured status are associated with decreased likelihood of receiving HCC screening. These disparities in screening impact stage at presentation as patients who are diagnosed through screening present at earlier stages of disease compared to patients who are diagnosed due to symptoms. Socioeconomic status, geography, race, and ethnicity are all associated with receipt of treatment and survival after HCC diagnosis. Guided by the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework, this work aims to present a comprehensive overview of disparities in HCC risk, screening, diagnosis, treatment, and outcomes.