SOURCE INFORMATION From the Section of Gastroenterology and Hepatology, Michael E. DeBakey Veterans Affairs Medical Center; Baylor College of Medicine; and the Houston Center for Quality of Care and Utilization Studies — all in Houston. Dr. El-Serag reports receiving consulting fees from Vertex Pharmaceuticals and support from a grant from Bayer Pharmaceuticals to the Baylor College of Medicine.

Disclosure forms provided by the author are available at NEJM.org.

No other potential conflict of interest relevant to this article was reported.

This article has no abstract; the first 100 words appear below.

Each year, hepatocellular carcinoma is diagnosed in more than half a million people worldwide, including approximately 20,000 new cases in the United States.1,2 Liver cancer is the fifth most common cancer in men and the seventh in women. Most of the burden of disease (85%) is borne in developing countries, with the highest incidence rates reported in regions where infection with hepatitis B virus (HBV) is endemic: Southeast Asia and sub-Saharan Africa (Figure 1).3 Hepatocellular carcinoma rarely occurs before the age of 40 years and reaches a peak at approximately 70 years of age. Rates of liver cancer among . . .