Published online Nov 27, 2014. doi: 10.4254/wjh.v6.i11.783
Revised: August 8, 2014
Accepted: September 16, 2014
Published online: November 27, 2014
The incidence of hepatocellular carcinoma (HCC) is known to be high in West Africa with an approximate yearly mortality rate of 200000. Several factors are responsible for this. Early acquisition of risk factors; with vertical or horizontal transmission of hepatitis B (HBV), environmental food contaminants (aflatoxins), poor management of predisposing risk factors and poorly-managed strategies for health delivery. There has been a low uptake of childhood immunisation for hepatitis B in many West African countries. Owing to late presentations, most sufferers of HCC die within weeks of their diagnosis. Highlighted reasons for the specific disease pattern of HCC in West Africa include: (1) high rate of risk factors; (2) failure to identify at risk populations; (3) lack of effective treatment; and (4) scarce resources for timely diagnosis. This is contrasted to the developed world, which generally has sufficient resources to detect cases early for curative treatment. Provision of palliative care for HCC patients is limited by availability and affordability of potent analgesics. Regional efforts, as well as collaborative networking activities hold promise that could change the epidemiology of HCC in West Africa.
Core tip: It is known that outside the region of East Asia, sub-Saharan Africa has the highest incidence of hepatocellular carcinoma (HCC). Within Africa the West African region remains the focus of significant disease activity. We reviewed the main issues responsible for this pattern. Although intervention efforts, such as primary prevention through hepatitis B vaccination, has led to reductions of chronic hepatitis B infection in some countries such as Gambia and Senegal, there remains a huge gap in secondary prevention, which are responsible for continuing high mortality to incidence ratio of HCC in West Africa. Collaborative clinical care and basic science translational research holds promise towards changing the current trend.