Real-World Challenges in Hepatocellular Carcinoma in Central America and the Caribbean: Insights from a multinational expert survey

Christie Perello^1,2Hugo Disla²Pablo Coste³Marisabell Valdez⁴Dayron Páez⁵Carlos Rivera⁶Yong Loo⁷Tania Mayorga⁸Kenia Torres⁹Edwyn Pol¹⁰Enrique Adames¹¹Miguel Mayo¹¹Louis M Morel¹²Rafael Gutierrez¹³Jose Luis Calleja^14,2*

• ¹Hepatology Unit, Hospital Metropolitano de Santiago, Santiago De Los Caballeros, Dominican Republic
• ²Instituto de Investigacion Sanitaria Puerta de Hierro - Segovia de Arana, Majadahonda, Spain
• ³Liver Unit, Hospital Rafael Angel Calderon Guardia, San José, Costa Rica
• ⁴Clínica Médicos Especialistas, MEDIGASTRO Group, San Salvador, El Salvador
• ⁵Hospital Clinico Quirurgico Hermanos Ameijeiras, Havana, Cuba
• ⁶Hospital Escuela and Honduras Medical Center, Tegucigalpa, Honduras
• ⁷Instituto Oncologico Nacional, Panama City, Panama
• ⁸Hospital Militar Escuela Dr Alejandro Davila Bolanos, Managua, Nicaragua
• ⁹Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
• ¹⁰Centro Médico Humberto Molina, Oncology Medical Clinic, Quetzaltenango, Guatemala
• ¹¹Department of Medicine, Gastroenterology Service, Hospital Santo Tomas, Panama City, Panama
• ¹²Department of Radiology, Centros de Diagnostico y Medicina Avanzada y de Conferencias Medicas y Telemedicina, Santo Domingo, Dominican Republic
• ¹³Cancer Center, Hospital Metropolitano de Santiago, Santiago De Los Caballeros, Dominican Republic
• ¹⁴Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain

Hepatocellular carcinoma (HCC) represents a growing public health concern in Central America and the Caribbean, yet regional data on its management remain limited. A cross-sectional descriptive survey was conducted among 51 liver cancer specialists across nine countries, exploring four domains: epidemiology, screening, diagnostics, and treatment access. Analysis of the 20-item questionnaire revealed significant disparities in HCC care across the region. National cancer registries and structured screening programs were largely absent. Although ultrasound was widely available, its routine use for surveillance was inconsistent, and radiologist training levels varied. Access to diagnostic imaging such as triphasic computed tomography and magnetic resonance imaging was uneven. While liver surgery was generally accessible, liver transplantation was limited to Costa Rica and, to a lesser extent, the Dominican Republic. Systemic therapies such as sorafenib and lenvatinib were commonly available, However, access to first-line immunotherapy was constrained by limited insurance coverage and delayed governmental approval. In several countries, fewer than 30% of patients received treatment approval, with delays exceeding five months. Multidisciplinary tumor boards were not routinely implemented. In conclusion, these findings provide the first regional overview of HCC management in Central America and the Caribbean, underscoring critical gaps in surveillance infrastructure, diagnostic capacity, therapeutic access, and institutional coordination. Addressing these gaps is essential to improving liver cancer outcomes and equity across the region.