Reasons why West Africa continues to be a hotbed for hepatocellular carcinoma

Tognarelli, Joshua M.; Ladep, Nimzing G.; Crossey, Mary M.E.; Okeke, Edith; Duguru, Mary; Banwat, EB; Taylor-Robinson, Simon D

doi:10.4103/0300-1652.165032

Cited by 23 publications

(14 citation statements)

References 44 publications

(56 reference statements)

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“…The male predominance seen in this report has been previously reported in Ghana, West Africa and globally [ 10 - 12 ]. This has previously been attributed to the higher prevalence of risk factors including chronic viral hepatitis, environmental carcinogens like alcohol and smoking, higher testosterone levels and lower levels of IL-6 production in males [ 13 , 14 ]. Indeed in this study, higher prevalence of alcohol use and smoking was found in males than females.…”

Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data

Tachi¹,

Agyei-Nkansah²,

Archampong³

2020

Pan Afr Med J

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Introduction Hepatocellular carcinoma (HCC) is a cancer of global public health concern because of its high incidence and mortality. The impact is greatest in areas with high prevalence of its major risk factors including chronic hepatitis B virus (HBV). HBV is endemic in Ghana but a comprehensive data on HCC is lacking. The aim of this study was to describe the clinical, laboratory and radiological features of HCC at the Korle Bu Teaching Hospital in Ghana. Methods The medical records of 194 HCC cases attended to at the Gastrointestinal Clinic of the Korle Bu Teaching Hospital between January 2015 and December 2018 were retrospectively analyzed for demographic, clinical, laboratory and radiological data. Results The male: female ratio was 2:1 and mean age was 45.2 years. Weight loss and abdominal pain were the major presenting symptoms. No patients were identified through surveillance. HBsAg was positive in 109/145 (75.2%) of cases tested. Sixty-five (59.6%) of 109 HBsAg positives were aware of their HBsAg status but only 3 were receiving medical follow ups prior to the diagnosis of HCC. Raised alpha-fetoprotein level >165.2 IU/ML was found in 53.9%. One hundred and forty-four patients were eligible for only analgesia. Conclusion HBV infection is the leading aetiologial risk factor associated with HCC. Majority of HBV carriers are aware of their status but do not receive care prior to HCC diagnosis. Majority present late and are eligible for only palliative treatment. Improvement in the health seeking behavior of HBV carriers can aid early detection of HCC.

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Section: Discussionmentioning

confidence: 99%

Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data

Tachi¹,

Agyei-Nkansah²,

Archampong³

2020

Pan Afr Med J

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“…Lack of confidence on the available health infrastructure on the part of the patient, contributes to poor health-seeking attitudes and this culminates to poor management of the disease. Unavailability of resources, health infrastructure, and high cost of treatment are important contributory factors, as well [ 74 ]. In addition, incorrect or missed diagnosis in suspected HILI cases is a major cause for concern, because delayed administration of adequate therapy is associated with the risk of prolonged or permanent health hazards [ 9 ].…”

Section: Current Status Of Knowledgementioning

confidence: 99%

Herb-Induced Liver Injuries in Developing Nations: An Update

Amadi

Orisakwe

2018

Toxics

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The last few decades have seen a rise in the use of herbal supplements, natural products, and traditional medicines. However, there are growing concerns related to the safety and toxicities of these medicines. These herbal medicines are associated with complications such as liver damage with a high incidence of mortalities and morbidities. Clinical manifestations range from asymptomatic cases with abnormal liver functions tests to sudden and severe liver failure necessitating liver transplantation. This work aimed to review the etiology, risk factors, diagnosis, clinical manifestations and selected clinical case reports of herbal hepatotoxicity in developing nations. PubMed and Google Scholar searches were undertaken to identify relevant literature. Furthermore, we scanned the reference lists of the primary and review articles to identify publications not retrieved by electronic searches. Little data exists on clinical cases of herb-induced liver injury in some developing countries such as Nigeria, as most incidences are either not reported to health care providers or reports from hospitals go unpublished. Studies in Nigeria have highlighted a possible correlation between use of herbs and liver disease. In Uganda, and association between the use of traditional herbal medicine with liver fibrosis in HIV-infected and non-HIV patients was demonstrated. Reports from China have revealed incidences of acute liver failure as a result of herbal medicine use. The actual incidence and prevalence of HILI in developing nations remain largely unknown due to both poor pharmacovigilance programs and non-application of emerging technologies. Improving education and public awareness of the potential risks of herbals and herbal products is desirable to ensure that suspected adverse effects are formally reported. There is need for stricter regulations and pre-clinical studies necessary for efficacy and safety.

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“…Liver cancer is the third commonest cancer in Nigerian men after prostate and colorectal cancers ( 31 ), and is a common cancer in other parts of West Africa ( 37 , 38 ). It contributed to approximately one-third of all alcohol associated cancers in men in this study.…”

Section: Discussionmentioning

confidence: 99%

“…It has been estimated that 47% of all liver cancers in SSA are attributable to Hepatitis infections while a significant proportion of the remainder are due to alcohol consumption ( 41 ). The predominance of liver cancers in men is thought to be due to the higher rate of risk factors including viral hepatitis, cigarette smoking, and alcohol consumption in men than in women ( 37 ).…”

Section: Discussionmentioning

confidence: 99%

Cancers Attributable to Alcohol Consumption in Nigeria: 2012–2014

et al. 2017

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IntroductionAlcohol consumption has been identified as a risk factor for many cancers but less attention has been paid to the fraction of those cancers that are attributable to alcohol consumption. In this study, we evaluated the incidence and population attributable fraction (PAF) of cancers associated with alcohol consumption in Nigeria.MethodsWe obtained data on incidence of cancers from two population-based cancer registries (PBCRs) in Nigeria and identified cancer sites for which there is strong evidence of an association with alcohol consumption based on the International Agency for Research on Cancer Monograph 100E. We computed the PAF for each cancer site by age and sex, using prevalence and relative risk estimates from previous studies.ResultsBetween 2012 and 2014 study period, the PBCRs reported 4,336 cancer cases of which 1,627 occurred in males, and 2,709 occurred in females. Of these, a total of 1,808 cancer cases, 339 in males and 1,469 in females, were associated with alcohol intake. The age standardized incidence rate (ASR) of alcohol associated cancers was 77.3 per 100,000. Only 4.3% (186/4,336) of all cancer cases or 10.3% (186/1,808) of alcohol associated cancers were attributable to alcohol consumption. Some 42.5% (79/186) of these cancers occurred in males while 57.5% (107/186) occurred in females. The ASR of cancers attributable to alcohol in this population was 7.2 per 100,000. The commonest cancers attributable to alcohol consumption were cancers of the oral cavity and pharynx in men and cancer of the breast in women.ConclusionOur study shows that 4.3% of incident cancers in Nigeria can be prevented by avoiding alcohol consumption. While the incidence of cancers associated with alcohol intake is high, the proportion attributable to alcohol consumption is much lower suggesting that the number of cancers that may be prevented by eliminating alcohol intake in this population is relatively low.

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Reasons why West Africa continues to be a hotbed for hepatocellular carcinoma

Cited by 23 publications

References 44 publications

Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data

Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data

Herb-Induced Liver Injuries in Developing Nations: An Update

Cancers Attributable to Alcohol Consumption in Nigeria: 2012–2014

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