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About 35,660 cases in the United States in 2015, but worldwide this may be the most common tumor; 24,550 deaths in 2015 in United States. Male:female = 4:1; tumor usually develops in cirrhotic liver in persons in fifth or sixth decade. High incidence in Asia and Africa is related to etiologic relationship between this cancer and hepatitis B and C infections. Effective vaccines for hepatitis B prevention and successful chemotherapy of hepatitis C should reduce the incidence. Aflatoxin exposure contributes to etiology and leaves a molecular signature, a mutation in codon 249 of the gene for p53.