Hepatocellular Carcinoma in Sub-Saharan Africa

Abstract

More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced symptomatic disease as a result of underdeveloped surveillance practices. Moreover, access to care and resource limitations further limit outcomes for the patients who receive a diagnosis in SSA. There is a need for multipronged strategies to decrease the incidence of HCC and improve its outcomes in SSA.

The hepatocellular carcinoma's risk factors among in-hospital patients at the university-teaching hospital Yalgado Ouédraogo in Ouagadougou, Burkina Faso: A case-control study

“…The hepatocellular carcinoma (HCC) remains one of the most frequent cancers in Africa. 1,2 Globally, the chronic carriage of the hepatitis B virus (HBV) or hepatitis C virus (HCV) are major etiological factors of liver cancers. The HBV infection would be responsible of half of all cases of HCC.…”

“…HBV infection share the same vulnerable groups with the HIV infection, which include injectable drug users, men who have sex with men, hemodialysis patients, health care workers and children born to mothers carrying the surface antigen of the HBV (HbsAg positive). 2,4,5 In Burkina Faso, according to GLOBOCAN, the primary liver cancer would be the third most frequent cancer (following the cervical and breast cancer). It would be the second cause of mortality by cancer following the cervical cancer.…”

Physician- and patient-reported barriers to hepatocellular carcinoma surveillance: A nationwide survey

“…Due to resource limitation, surveillance might still be difficult to achieve despite sufficient physicians’ knowledge and proactive attitudes toward surveillance, and these were also documented as barriers in many other countries with limited resources. [17] One of the possible causes of inadequate healthcare resources might be due to insufficient healthcare fundings. It was shown that low- and middle-income countries distributed smaller funds to healthcare expenditures than high-income countries.…”

Hepatocellular carcinoma in Hepatitis B and Human Immunodeficiency Virus coinfection in Africa: a focus on surveillance

“…Patients with HCC in Africa have among the lowest reported survival rates in the world, particularly when compared to patients from higher income countries [ 69 , 70 ] . A major contributor to this wide disparity in mortality is late presentation and diagnosis, in addition to a relative paucity of disease screening and HCC surveillance.…”