Liver Cancer In Africa Research Articles

Decrease in liver cancer incidence rates in Bamako, Mali over 28 years of population-based cancer registration (1987-2015).

BACKGROUNDPrimary liver cancer is common in West Africa due to endemic risk factors. However, epidemiological studies of the global burden and trends of liver cancer are limited. We report changes in trends of the incidence of liver cancer over a period of 28 years using the population-based cancer registry of Bamako, Mali.AIMTo assess the trends and patterns of liver cancer by gender and age groups by analyzing the cancer registration data accumulated over 28 years (1987-2015) of activity of the population-based registry of the Bamako district.METHODSData obtained since the inception of the registry in 1987 through 2015 were stratified into three periods (1987-1996, 1997-2006, and 2007-2015). Age-standardized rates were estimated by direct standardization using the world population. Incidence rate ratios and the corresponding 95% confidence intervals (CI) were estimated using the early period as the reference (1987-1996). Joinpoint regression models were used to assess the annual percentage change and highlight trends over the entire period (from 1987 to 2015).RESULTSAmong males, the age-standardized incidence rates significantly decreased from 19.41 (1987-1996) to 13.12 (1997-2006) to 8.15 (2007-2015) per 105 person-years. The incidence rate ratio over 28 years was 0.42 (95%CI: 0.34-0.50), and the annual percentage change was -4.59 [95%CI: (-6.4)-(-2.7)]. Among females, rates dropped continuously from 7.02 (1987-1996) to 2.57 (2007-2015) per 105 person-years, with an incidence rate ratio of 0.37 (95%CI: 0.28-0.45) and an annual percentage change of -5.63 [95%CI: (-8.9)-(-2.3)].CONCLUSIONThe population-based registration showed that the incidence of primary liver cancer has steadily decreased in the Bamako district over 28 years. This trend does not appear to result from biases or changes in registration practices. This is the first report of such a decrease in an area of high incidence of liver cancer in Africa. This decrease may be explained by the changes and diversity of diet that could reduce exposure to aflatoxins through dietary contamination in this population.

Epidemiology of Liver Cancer in Africa: Current and Future Trends.

Hepatocellular carcinoma (HCC) is a disease of global public health significance with mortality on the rise, despite the preventable nature of its risk factors especially in Africa. It is now the sixth most common cancer worldwide, fifth in males, and ninth in females. HCC incidence and mortality are predicted to increase in African countries constrained by limited resources to combat endemic levels of viral infection and synergistic environmental risk factors. The changing nature of HCC etiology is particularly illustrated here with the traditional risk factors like viral hepatitis coexisting alongside high human immunodeficiency virus (HIV) prevalence and rapidly increasing urbanization that have promoted a sharp increase in additional risk factors like coinfection, type 2 diabetes mellitus, and obesity. Although there are some differences in etiology between North Africa and sub-Saharan Africa, risk factors like chronic viral hepatitis B and C, aflatoxin exposure, and iron overload predominate. Aggressive hepatitis B genotypes, combined with hepatitis B virus/hepatitis C virus/HIV coinfections and aflatoxin exposure, promote a more aggressive molecular phenotype. In parallel to a better understanding of the molecular etiology of HCC, policy and planning initiatives to address the burden of HCC must be anchored within the reality of the limited resources available. Establishment and coordination of cancer registries across Africa is needed to improve the quality of data necessary to galvanize action. Preventive measures including hepatitis B vaccination programs, measures to prevent maternal-to-child and child-to-child transmission, delivery of universally accessible antiretroviral and antiviral treatments, and reduction of dietary aflatoxin exposure can contribute markedly to reduce HCC incidence. Finally, the development of biomarkers and new therapeutic interventions will need a better understanding of the unique genetic and epigenetic characteristics of HCC on the continent. We present a narrative review of HCC in Africa, discussing present and future trends.

Cancer prevention in Africa: liver cancer.

Hepatocellular carcinoma is a common cancer in Africa. The risk factors are well known and avoidable in most cases (hepatitis B, hepatitis C, aflatoxin and alcohol). Vaccination against hepatitis B and the fight against aflatoxin are efficient contributions to the fight against liver cancer. The costly nature of these measures in Africa is an impediment to the fight against liver cancer in Africa.

Cancer prevention and control: hepatocellular carcinoma.

Liver cancer (mostly hepatocellular carcinoma, HCC) is both common and highly lethal throughout Africa, in particular in western and middle Africa where HCC is the first cause of cancer death in men and the third in women. In these high-incidence areas, HCC develops mostly early (<50 years), with an aggressive clinical course and frequently without prior diagnosis of liver cirrhosis. The dynamics of African populations predict that the burden of liver cancers will be multiplied by three to four in the next decades unless effective prevention and therapy is achieved. This article outlines a path for significantly curbing the mortality of liver cancer in Africa by combining primary prevention, improved early detection and introduction of innovative and appropriate management strategies.

Liver cancer in Africa: untold aspects of an acknowledged scourge

Liver cancer in Africa: untold aspects of an acknowledged scourge

Screening and treatment of hepatitis B virus to prevent liver cancer in Africa.

Q Dr Thursz, can you tell us a little about your professional background to date? I initially trained in internal medicine and gastroenterology. I was given the opportunity to train in Hepatology at St Mary’s Hospital in 1990 by Prof Howard Thomas, who at that time was very active in the field of viral hepatitis and had also set up a liver transplant program. I undertook research at St Mary’s Hospital Medical School which subsequently became Imperial College between 1991 and 1994 studying immunogenetics of hepatitis B virus infection. I was fortunate enough to collaborate with Prof Adrian Hill from Oxford, which resulted in a number of high-impact publications on genetic susceptibility in hepatitis B virus infection [1–4]. I became lecturer and then senior lecturer at Imperial, working mostly on genetic susceptibility in viral hepatitis but also studying the natural history of hepatitis C virus infection. In 2002, I became secretary of the British Association for Study of the Liver, a position I held for 3 years. On the retirement of Prof Thomas in 2011, I was appointed head of the Section of Hepatology and Gastroenterology at Imperial College. In 2009, I was elected to the Governing Board of the European Association for Study of the Liver (EASL) as Vice-Secretary, and from 2011 to 2013 I served as SecretaryGeneral of EASL. My department is involved in a wide range of basic, translational and clinical research in liver disease. We have participated in many of the recent Phase II and III trials of direct acting antivirals for hepatitis C virus infection. I have just completed a large trial of treatment for alcoholic hepatitis evaluating the role of steroids and pentoxifylline.

Call for more HBV vaccination in Africa

Researchers involved in a decade-long programme in the Gambia announced at an international medical conference on March 11 their hopes that widespread use of a hepatitis B virus (HBV) vaccine can greatly reduce the incidence of liver cancer in Africa.

Environmental chemical carcinogens and liver cancer

An appraisal is made of these chemical carcinogens available in the human environment that have been implicated in the etiology of liver cancer. The possible role of mycotoxins is discussed in detail, in particular the association between the aflatoxins and liver cancer in Africa and the Far East.

Dietary aflatoxins and human liver cancer. A study in Swaziland.

A study in Swaziland to assess the possible relationship of aflatoxin contamination and the incidence of primary liver cancer is reported. Aflatoxin ingestion levels have been determined in "food from the plate" samples collected over a 1-year period. A significant correlation between the calculated ingested daily dose and the adult male incidence of primary liver cancer in different parts of Swaziland has been established. Samples of foodstuffs other than the plate samples also reflected the correlation of aflatoxin contamination and liver cancer. This study extends and amplifies the findings of an earlier study in the Murang'a district of Kenya and supports the hypothesis that aflatoxin ingestion is a factor in the genesis of primary liver cancer in Africa.

Histologic changes in livers of pyridoxine-deprived baboons--relation to alpha1 fetoprotein and liver cancer in Africa.

Histologic changes in livers of pyridoxine-deprived baboons--relation to alpha1 fetoprotein and liver cancer in Africa.

Carcinogenicity of sterigmatocystin

The mycotoxin, sterigmatocystin, was administered to rats in doses of 0·15–2·25 mg/day by gavage or in the diet for 52 wk. Eight rats which received a high dose (1·5–2·25 mg/day) of sterigmatocystin died between wk 5 and 18, while 39 out of the 50 treated rats surviving to wk 42 eventually developed hepatocellular carcinoma. Of these, 31 had varying degrees of fibrosis. Eight tumours of other types were seen in various organs and acanthotic changes occurred in the stomachs of 85% of the treated rats. The lesions produced in the livers of rats exposed to sterigmatocystin are similar to those found in Bantu hepatoma and ‘toxic’ hepatitis. These findings support the hypothesis that the high incidence of liver cancer in Africa may be related to the ingestion of mycotoxins.

Carcinogenicity of sterigmatocystin

Abstract The mycotoxin, sterigmatocystin, was administered to rats in doses of 0·15–2·25 mg/day by gavage or in the diet for 52 wk. Eight rats which received a high dose (1·5–2·25 mg/day) of sterigmatocystin died between wk 5 and 18, while 39 out of the 50 treated rats surviving to wk 42 eventually developed hepatocellular carcinoma. Of these, 31 had varying degrees of fibrosis. Eight tumours of other types were seen in various organs and acanthotic changes occurred in the stomachs of 85% of the treated rats. The lesions produced in the livers of rats exposed to sterigmatocystin are similar to those found in Bantu hepatoma and ‘toxic’ hepatitis. These findings support the hypothesis that the high incidence of liver cancer in Africa may be related to the ingestion of mycotoxins.