Unique situation of hepatocellular carcinoma in Egypt: A review of epidemiology and control measures

Abstract

Hepatocellular carcinoma (HCC) is the sixth most common primary malignancy worldwide, and the third most common cause of death among cancers worldwide. HCC occurs in several pre-existing conditions, including hepatitis C, hepatitis B virus, and non-alcoholic cirrhosis. Egypt used to be the country with the heaviest hepatitis C virus (HCV) burden. The relationship between HCV and HCC is an important research area. In Egypt, HCC is a significant public health problem. A possible cause for the increasing rates of detection of HCC in Egypt is the mass screening program that was carried by the government for detecting and treating HCV. A multidisciplinary approach is now widely applied to HCC management in health centers all over Egypt. Different treatment modalities are available in Egypt, with success rates comparable to global rates. The Egyptian health authorities have made the elimination of HCV from Egypt a special priority, and this approach should lead to a decrease in number of HCC cases in the near future. In this article we review the current situation of HCC in Egypt, including epidemiological aspects, relevant risk factors for HCC development, strategies, and efforts established by health authorities for the screening and prevention of both HCV and HCC in Egypt. We highlight the different modalities for HCC treatment.

Hepatocellular Carcinoma in Africa: Challenges and Opportunities

“…HCV prevalence in SSA and North Africa is estimated at 2.1-3.3% and 2.3-7.7%, respectively (15). Chronic HCV infection has also been identified as the primary cause of HCC in North Africa (particularly Egypt) (16) and in central Africa (Cameroon) (17). Being the country with the highest worldwide prevalence of HCV, the Egyptian Ministry of Health (MOH) launched a large national screening program that intended to screen the whole country citizens (18).…”

“…All screened subjects with proven HCV infection were referred for engagement in a government-funded treatment program employing direct-acting antiviral (DAA). However, there is still no national campaign for HCC surveillance (16). Given the magnitude of Egypt's HCV and HCC problems, the extensive HCV treatment program could significantly impact the country's HCC figures shortly (19).…”

“…It has been worth mentioning that the characteristics and risk factors of HCC differ in Egypt from other African countries (16). Additionally, the proportion of patients receiving specific treatment in other African countries appears to be low, and their outcomes were extremely poor.…”

Hepatocellular carcinoma pathogenesis: Epigenetics and relationship with cancer hallmarks

“…Firstly, Egypt has a high recorded HCV transmission rate. According to the Egyptian ministry of health (MOH) screening program that took place over 7 months with a target population of 62.5 million, 49.6 million persons were screened for HCV antibodies, 2.4 million seropositive persons were identified, and 1.6 million viremic patients were identified (Ezzat et al, 2021). Secondly, there is known to be a relationship between HCV and HCC development.…”

“…Secondly, there is known to be a relationship between HCV and HCC development. Thirdly, the programmed screening and follow up that was initiated by the government detected cases of individuals having both diseases (Ezzat et al, 2021). According to a study carried out by Ziada et.…”