Editorial
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 7, 2018; 24(37): 4224-4229
Published online Oct 7, 2018. doi: 10.3748/wjg.v24.i37.4224
Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges
Federico Piñero, Jaime Poniachik, Ezequiel Ridruejo, Marcelo Silva
Federico Piñero, Ezequiel Ridruejo, Marcelo Silva, Liver Unit, Hospital Universitario Austral, Facultad de Ciencias Biomédicas, Universidad Austral, Pilar, Buenos Aires B1629HJ, Argentina
Federico Piñero, Ezequiel Ridruejo, Marcelo Silva, Latin American Liver Research Educational and Awareness Network, Buenos Aires B1629HJ, Argentina
Jaime Poniachik, Department of Gastroenterology and Hepatology, Hospital Clínico Universidad de Chile, Santiago de Chile, Región Metropolitana Santiago 46010, Chile
Jaime Poniachik, Gastroenterology and Hepatology, Clínica Santa María, Santiago de Chile, Región Metropolitana Santiago 834-0518, Chile
Ezequiel Ridruejo, Hepatology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Ciudad de Buenos Aires C1425ASG, Argentina
Author contributions: Piñero F and Poniachik J contributed to concept and writing of the article; Ridruejo E and Silva M contributed to critical review and final approval of the article.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Federico Piñero, MD, MSCE, Academic Research, Doctor, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Av. Presidente Perón 1500, Pilar, Buenos Aires B1629HJ, Argentina. fpinerof@cas.austral.edu.ar
Telephone: +54-230-4482000 Fax: +54-230-4482236
Received: July 5, 2018
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
Abstract

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.

Keywords: Latin America, Liver cancer, Limitations, Challenge

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.