Secular Trends and Geographic Variations of Hepatitis B Virus and Hepatitis C Virus-Associated Hepatocellular Carcinoma in South Punjab

Abstract

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and represents one of the leading causes of cancer-related mortality worldwide. Approximately 75–90% of HCC cases develop on the background of chronic liver disease, with chronic Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections being the principal etiological factors. The burden of HCC is disproportionately higher in low-and middle-income countries, particularly in Asia and Africa, where chronic viral hepatitis remains endemic. Pakistan is among the countries with a high prevalence of HBV and HCV infections, making HCC an increasingly significant public health concern. South Punjab, owing to its demographic, socioeconomic, and healthcare disparities, experiences a particularly high burden of chronic liver disease. Understanding the temporal trends and geographical distribution of HBV-and HCV-associated HCC is essential for designing effective prevention and control strategies.To evaluate the secular trends, demographic characteristics, and geographical variations of HBV-and HCV-associated hepatocellular carcinoma in South Punjab, and to examine their implications for disease prevention, clinical management, and public health policy. This expanded review also synthesizes available scientific evidence regarding the epidemiology, risk factors, pathogenesis, diagnosis, prevention, and future challenges associated with HCC.This work is based on the available study data from Bahawalpur Institute of Nuclear Medicine and Oncology (BINO) together with a comprehensive review of published scientific literature. Demographic characteristics, viral etiologies, regional distribution, and temporal trends are discussed in the context of national and international evidence. Relevant epidemiological observations have been critically interpreted to provide a broader understanding of HCC patterns in South Punjab.The available data indicate that HCV remains the predominant etiological factor associated with hepatocellular carcinoma inSouth Punjab, whereas HBV constitutes the second most important viral cause. Most patients are middle-aged males, and considerable geographical variation exists among different districts. The incidence of HCC has demonstrated an increasing trend over the study period, reflecting the persistent burden of chronic viral hepatitis.The increasing burden of hepatocellular carcinoma in South Punjab emphasizes the urgent need for strengthened HBV vaccination programs, expanded HCV screening initiatives, timely antiviral treatment, improved surveillance systems, and region-specific healthcare policies. Comprehensive prevention strategies remain the most effective approach for reducing future morbidity and mortality associated with HCC.