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Hepatocellular carcinoma (HCC), the most common type of liver cancer, affects women and men at similar rates in Mexico; however, men are more likely to present with the disease in an advanced stage, according to a multi-institutional study published in the journal Diseases.

This study analyzed retrospective clinical and demographic data from the medical records of 697 patients with HCC treated at various institutions across Mexico between 2015 and 2022. The data were collected as part of a national survey. The research team calculated the proportion of cases by region and stratified the results based on sex.

The average age at diagnosis was 65.4 years, with a range of ±11.9 years, and one fifth of patients aged 75 years or older were diagnosed. The male-to-female ratio was 1.4:1, ranging from 1:1 in the northwest and southwest regions to 2.1:1 in the western region. Cirrhosis rates were similar between the sexes; however, the causes differed. Women had more cases of unknown etiology, whereas alcohol-related cirrhosis was more common in men.

Regional Variations

Regional disparities in risk factors, such as hepatitis B and C infections, excessive alcohol consumption, exposure to aflatoxin B1, a carcinogenic toxin from contaminated corn, and metabolic dysfunction–associated steatotic liver disease (MASLD), may explain these sex-based differences in HCC incidence.

In contrast to global trends, where HCC mortality disproportionately affects men (2.7:1), Mexico exhibits a unique epidemiological pattern, with mortality rates nearly equal between men and women (1:1). The study also documented a higher disease burden in rural areas.

As the researchers noted, the limited data on risk factor distribution and clinical characteristics by sex prompted this investigation.

Risk Factors

However, in achieving these findings, the researchers encountered several limitations, including the absence of a national cancer registry in Mexico, variability in the quality of clinical records, and differences in diagnostic methods used to classify HCC.

"In the end, we managed to create a multicenter database unprecedented in Mexico," said lead author Javier Melchor Ruan, MD, a hepatopancreatobiliary oncologic surgeon from Instituto Nacional de Cancerología, Mexico City, Mexico, in an interview with Medscape’s Spanish edition.

"This work will help us better understand liver cancer in Mexico and improve prevention, detection, and treatment strategies," he said.

Clinical Implications

Melchor Ruan emphasized that this research was the result of a multicenter collaborative effort within the Mexican Interdisciplinary Network for Research on Hepatocellular Cancer, founded in 2021 in partnership with Martín Lajous, MD, PhD, and Adriana Monge, MS, MPH, of the Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico.

Their goal was to analyze the epidemiology of HCC in Mexico and identify differences in risk factors across patient populations.

"This article is a great piece of research and presents intriguing findings," said Carmen Palacios Reyes, PhD, specialist in medical genetics. She referred to a separate study, in which she was the corresponding author, that examined recent changes in the etiology of liver cirrhosis in Mexico.

Expert Insights

Palacios Reyes, from the University of Guanajuato in León, Mexico, explained that while the study led by Melchor Ruan found a higher prevalence of HCC in men, her own research showed a higher proportion of deaths from liver disease in men than in women between 2013 and 2022. “This is related to the higher frequency of HCC in men in this study [led by Melchor Ruan]. However, the differences between genders that they found were much smaller than those we identified,” she noted.

According to Palacios Reyes, these differences may be partially explained by the fact that mortality from MASLD is significantly higher in men than in women, as it includes causes beyond cirrhosis. Consequently, for other liver-related causes of death, the disparities between sexes are less pronounced.

Melchor Ruan emphasized that the differences in HCC prevalence between men and women in their study are not solely due to variations in risk factors but may also be influenced by disease biology, healthcare access, and environmental conditions.

"While in men alcohol is a predominant cause of cirrhosis, in women liver damage is usually more related to metabolic factors such as obesity and metabolic syndrome, and since obesity is more common in women in Mexico, this could explain why fatty liver is a more frequent cause of HCC in them," he said.

Future Directions

According to the Global Cancer Observatory, a database maintained by the International Agency for Research on Cancer under the World Health Organization, liver cancer was the eighth most common cancer and the fourth leading cause of cancer mortality in Mexico in 2022.

Melchor Ruan emphasized the role of environmental factors, particularly exposure to aflatoxins found in foods like corn, as multiple studies have linked these toxins to liver cancer.

"Differences in food consumption patterns could also influence geographic variations in HCC," he noted.

He also pointed out that disparities in healthcare access may lead to late diagnoses in some regions, increasing the number of advanced-stage cases.

"In general, men tend to delay their medical care, which could contribute to them being diagnosed at more advanced stages. In contrast, in regions with better medical infrastructure and screening programs, diagnosis is more likely to occur at an early stage," he said.

To address these challenges, he called for tailored detection and treatment of HCC, considering both sex and regional differences. "For men, it is necessary to strengthen strategies to reduce alcohol consumption, while in women we must focus on the prevention and control of fatty liver and metabolic syndrome," he emphasized.

Additionally, he stressed the importance of maintaining hepatitis B vaccination coverage and ensuring timely hepatitis C treatment, as viral infections remain significant risk factors for HCC. He also recommended improving food quality control to minimize aflatoxin exposure and increasing health education to reduce late diagnosis, particularly among men.

Palacios Reyes concurred on the need for broader liver disease detection programs, particularly for MASLD and other lesser-known causes of liver damage. "It is essential to implement screening guidelines based on risk factors and age groups. This must go hand in hand with proper management and follow-up, once the disease is detected, in order to prevent its progression and achieve its reversal or control," she stated.

She called for preventive measures to reduce the risk for metabolic diseases, emphasizing lifestyle changes as key risk factors for metabolic diseases. "Encouraging physical activity, maintaining a healthy weight, reducing processed food intake, ensuring hepatitis B vaccination, and limiting alcohol consumption are crucial steps," she concluded.

Melchor Ruan and Palacios Reyes had disclosed no relevant financial relationships.

This story was translated from Medscape’s Spanish edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.