Risk Factors for the Development of Hepatocellular Carcinoma in Thailand

Abstract

Hepatocellular carcinoma (HCC) is the most common type of liver cancer worldwide. The incidence of HCC is on the rise in Thailand, where it has become the most common malignancy in males and the third most common in females. Here, we review some of the risk factors that have contributed to this increase in HCC incidence in the Thai population. Hepatitis B virus (HBV) is the main etiologic risk factor for HCC, followed by hepatitis C virus (HCV). Patients with HBV genotype C have a higher positive rate of hepatitis B early antigen (HBeAg) and progress to cirrhosis and HCC earlier than genotype B. For HCV patients, 16% developed HCC associated cirrhosis by year 5 after diagnosis, and the cumulative risk for death from HCC at year 10 was 60%. Dietary exposure to the fungal hepatocarcinogen aflatoxin B1 has been shown to interact synergistically with HBV infection to increase the risk of early onset HCC. Chronic alcohol abuse remains an important risk factor for malignant transformation of hepatocytes, frequently in association with alcohol-induced cirrhosis. In recent years, obesity and metabolic syndrome have markedly increased the incidence of HCC and are important causes of HCC in some resource-rich regions.

Family history of liver cancer may indicate chronic hepatitis B virus infection in an endemic area

“…The prevalence of HBV infection in this study was 12.75%, which is higher than that in earlier reports [1,8]. There are two main reasons for this difference.…”

“…HBV increases the risk of hepatocellular carcinoma by 1 000 times and is considered a cause of at least 50% of cases of hepatocellular carcinoma [4][5][6][7]. In Thailand, the estimated age-standardized incidence rate for liver cancer is 40.6 per 100 000 in men [8]. These cases are most commonly caused by HBV infection (73.6%) [9].…”

“…The average age of HBV carriers at diagnosis was 30.9 years [8]. Risk factors for HBV infection may be different among countries and specific populations.…”

NEIL1 protects against aflatoxin-induced hepatocellular carcinoma in mice

“…aflatoxin | base excision repair | ring-fragmented purines | liver cancer | environmental toxicant L iver cancers pose an international public health concern as the second leading cause of cancer-related deaths worldwide, with >700,000 estimated deaths per year (1)(2)(3). This mortality approaches its annual incidence throughout the world, highlighting the need for development of effective treatments and early diagnostic tools.…”

The Relationship of Aflatoxin B1 and Hepatocellular Carcinoma: A Mini Review

“…Exposure to Aflatoxin is a major risk factor for the development of hepatocellular carcinoma (HCC), which is one of the most common malignancies worldwide [1,2]. Aflatoxins are secondary metabolites of Aspergillus flavus (AF) and Aspergillus parasiticus (AP), fungus that develops under characteristic environmental conditions that are related to high moisture and temperature, and is associated to storage of maize, groundnuts, wheat, soy and rice [3]; the Food and Drug Administration (FDA) has regulated aflatoxin levels for human consumption stablishing a level of 20 ng g -1 (20µg/Kg) total aflatoxin (B1, B2, G1, G2) [3,4].…”