The liver is an important organ that aids in blood glucose regulation and detoxification. An increasing number of liver cancer patients, particularly for hepatocellular carcinoma (HCC) is observed globally. HCC has poor prognosis among current patients, is one of the deadliest cancers and has seen cases risen by 100% between 1990 and 2017 [1]. Two primary reasons are due to population aging and growth. The underlying causes include viral hepatitis infections, alcohol consumption among others. An estimated two thirds of liver cancer deaths are dominated by viral hepatitis and hence prevention and control are desperately needed.

Primary prevention of hepatitis B (HBV) related HCC can be achieved through universal HBV vaccination and anti-viral prophylaxis for high viremic mothers. This has shown to be successful in numerous Asian countries with national immunization programs [2,3]. Together with other efforts to detect and link patients to care, liver cancer incident cases owing to HBV have decreased between 1990 and 2015, if the demographic profile and population size had remained the same. Consequently, HCC due to hepatitis C (HCV) is on the rise [1].
The best strategy to reduce HCC related deaths and other complications lies in early detection and providing access to care and treatment. Access to treatment is important to ensure the disease is controlled. In a study by Sung et al., they demonstrated the risk of HCC was reduced in HBV patients by nearly 80% in those on anti-viral treatment [4]. In HCV cases, successful treatment decreases risk of HCC in one study by Singal et al. [5]. HCV patients who achieved sustained virologic response (SVR) saw as estimated 70% reduction in HCC. This was similarly observed in a study by Ioannou GN et al [6] showing a 2 year follow up with patients having no cirrhosis with SVR to have most favorable probability free from HCC.

Current trends point towards a shift in the epidemiology of HCC. NAFLD or Metabolic (dysfunction)-associated fatty liver disease (MAFLD) is a major health problem and is rapidly becoming an important risk factor for liver cancer. In a study conducted in University Malaya, there is increasing evidence to show the influence of fatty liver/NASH in HCC cases in Malaysia. This changing pattern is largely attributed to obesity. In Asian patients with NAFLD, the annual incidence of HCC was 1·8 cases per 1000 person-years (0·8-3·1) and overall mortality rate was 5·3 deaths per 1000 person-years (1·5-11·4).

Attempts to reduce HCC should aim at prevention and control of chronic viral hepatitis and curbing the growing epidemic of obesity, diabetes and fatty liver disease.