Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4224
Peer-review started: July 5, 2018
First decision: August 1, 2018
Revised: August 2, 2018
Accepted: August 24, 2018
Article in press: August 24, 2018
Published online: October 7, 2018
Latin America, a region with a population greater than 600000000 individuals, is well known due to its wide geographic, socio-cultural and economic heterogeneity. Access to health care remains as the main barrier that challenges routine screening, early diagnosis and proper treatment of hepatocellular carcinoma (HCC). Therefore, identification of population at risk, implementation of surveillance programs and access to curative treatments has been poorly obtained in the region. Different retrospective cohort studies from the region have shown flaws in the implementation process of routine surveillance and early HCC diagnosis. Furthermore, adherence to clinical practice guidelines recommendations assessed in two studies from Brazil and Argentina demonstrated that there is also room for improvement in this field, similarly than the one observed in Europe and the United States. In summary, Latin America shares difficulties in HCC decision-making processes similar to those from developed countries. However, a transversal limitation in the region is the poor access to health care with the consequent limitation to standard treatments for overall population. Specifically, universal health care access to the different World Health Organization levels is crucial, including improvement in research, education and continuous medical training in order to expand knowledge and generation of data promoting a continuous improvement in the care of HCC patients.
Core tip: Which are the implications in regard to clinical decision making processes related to hepatocellular carcinoma (HCC) in daily practice in Latin America? Should we consider making these decisions taking into account both, local experiences and their feasibility together with the best available evidence in parallel with patient preferences? These decision-making processes must be individualized according to local barriers to health care systems. Primary prevention programs of liver diseases, surveillance for HCC and intervention programs following the best evidence will be possible only if we are aware of local barriers and develop efficient strategies to overcome them.