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

Hepatocellular carcinoma (HCC) remains a major global health burden, ranking as one of the leading causes of cancer-related deaths worldwide. This review synthesizes current evidence on HCC epidemiology, highlighting both modifiable and non-modifiable risk factors, 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 biological mechanisms but also broader social and environmental determinants of health, emphasizing the need for integrated, population-level preventive strategies. Effective strategies across all levels of prevention are reviewed. Primordial and primary prevention strategies include public health policies, health education to raise awareness, universal hepatitis B vaccination, expanded access to antiviral 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 hepatitis screening and routine HCC surveillance in high-risk populations. Tertiary prevention aims to reduce morbidity and mortality through timely treatment and multidisciplinary care. Despite the availability of effective tools, substantial implementation gaps remain persist. Underdiagnosis of viral hepatitis, low treatment uptake, inadequate surveillance coverage, and disparities in healthcare access continue to limit progress. Addressing these challenges requires a coordinated public health response grounded in health system 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 and action.