The incidence of hepatocellular carcinoma (HCC) has almost tripled since the early 1980s in the United States, where it is the fastest rising cause of cancerrelated deaths. 1 According to population-based Surveillance Epidemiology and End Results registry data, the overall HCC age-adjusted incidence rates for liver and intrahepatic ducts cancer is as high as 8 per 100,000 underlying population in 2010 (Fig. 1) of which at least 6 per 100,000 are related to HCC. Men are at approximately three times higher risk than women. Asian men (ie, Chinese, Korean, Filipino, and Japanese) have the highest age-adjusted incidence rates. However, the largest proportional increases have occurred among Hispanics followed by blacks and non-Hispanic whites, whereas the lowest proportional increases have occurred among Asians. In contrast to Asians/Pacific Islanders, HCC incidence rates are reported to be higher among Hispanics born in the United States than among foreign-born Hispanics. 2 HCC incidence rates have increased in each successive birth cohort born between 1900 and 19593 (Fig. 2). In addition, the age distribution of HCC patients has shifted to younger ages, with the greatest proportional increases among individuals 45-60 years old (Fig. 2). There is a south to north gradient in the incidence and mortality of HCC; southern states, including Texas, Louisiana, and Mississippi, have some of the highest HCC incidence rates in the nation (Fig. 3). In one study, Texas Latinos and, especially, South Texas Latinos had the highest age-adjusted HCC incidence rates (as high as 10.6 per 100,000). 4