Ladep NG, Lesi OA, Mark P, Lemoine M, Onyekwere C, Afihene M, Crossey MM, Taylor-Robinson SD. Problem of hepatocellular carcinoma in West Africa. World J Hepatol 2014; 6(11): 783-792 [PMID: 25429316 DOI: 10.4254/wjh.v6.i11.783]
Corresponding Author of This Article
Nimzing G Ladep, MBBS, PhD, FWACP, Hepatology Unit, Imperial College London, 10th Floor, QEQM Building, St Mary’s Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom. n.ladep@imperial.ac.uk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Topic Highlight
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World J Hepatol. Nov 27, 2014; 6(11): 783-792 Published online Nov 27, 2014. doi: 10.4254/wjh.v6.i11.783
Problem of hepatocellular carcinoma in West Africa
Nimzing G Ladep, Olufunmilayo A Lesi, Pantong Mark, Maud Lemoine, Charles Onyekwere, Mary Afihene, Mary ME Crossey, Simon D Taylor-Robinson
Nimzing G Ladep, Maud Lemoine, Mary ME Crossey, Simon D Taylor-Robinson, Hepatology Unit, Imperial College London, St Mary’s Hospital Campus, London W2 1NY, United Kingdom
Olufunmilayo A Lesi, Department of Medicine, College of Medicine, University of Lagos, Plateau State 930001, Nigeria
Pantong Mark, Department of Medicine, Jos University Teaching Hospital, Jos, Plateau State 930001, Nigeria
Charles Onyekwere, Department of Medicine, Lagos State University College of Medicine/Teaching Hospital, Lagos 100001, Nigeria
Mary Afihene, Department of Medicine, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
Author contributions: Ladep NG conceptualised, organised, wrote, corresponding author of article and approved final version; Lesi OA wrote sections of challenge of surveillance and treatment of HCC, corrected several other sections and approved final version; Mark P wrote sections of clinical presentations of HCC in West Africa, provided pictures for Figures 3 and 4 and approved final version; Lemoine M wrote the sections of challenges of diagnosis, treatment of HCC in West Africa and approved final version; Onyekwere C wrote section of reasons for poor survival of HCC in West Africa and approved final version; Afihene M co-wrote challenge of surveillance, treatment of HCC and approved final version; Crossey MME made several amendments, suggestions to improve article and approved final version; Taylor-Robinson SD is the guarantor of the article, co-wrote conclusions and recommendations with Ladep NG and approved final version.
Supported by Fellowships from The London Clinic, London, United Kingdom (to Dr. Ladep); from the Halley Stewart Foundation, Cambridge, United Kingdom (to Mary ME Crossey)
Correspondence to: Nimzing G Ladep, MBBS, PhD, FWACP, Hepatology Unit, Imperial College London, 10th Floor, QEQM Building, St Mary’s Hospital Campus, South Wharf Road, London W2 1NY, United Kingdom. n.ladep@imperial.ac.uk
Telephone: +44-20-33121909 Fax: +44-20-33123395
Received: July 4, 2014 Revised: August 8, 2014 Accepted: September 16, 2014 Published online: November 27, 2014 Processing time: 138 Days and 23.5 Hours
Abstract
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.
