Problem of hepatocellular carcinoma in West Africa

Table 1 Summary of some studies indicating male preponderance of hepatocellular carcinoma relative to other cancers in West Africa

Country	Liver cancer relative to cancer elsewhere	Source of study population	Coverage
Niger[55]	Most common in men; M:F ratio of 1.4:1	National cancer registry	National
The Gambia[56]	Most common in men; 2nd in women	National cancer registry	National
Ghana[57]	Most common in men, 3rd in women; M:F ratio of 1.2:1	Southern Ghana	Mortality data from a tertiary centre
Nigeria[58]	Most common in men; M:F ratio of 2.4:1	South East Nigeria	Cancer mortality data
Nigeria[59]	Most common in 50-59 years old	South West Nigeria	Pathology reports
Côte d’Ivoire[60]	Second in men; less common in women	Cancer registry	National
Mali[61]	Most common cancer in men; cervical cancer leads in women	Cancer registry	National
Guinea-Conakry[62]	Most common in men; second in women	Cancer registry	Regional

Table 2 Relative differences in risk factors, clinical features, surveillance and management of hepatocellular carcinoma between West Africa and developed countries

Parameter	Developed countries	West African countries
Predominant risk factor	Hepatitis C virus[2,63]	Hepatitis B virus[5]
Predominant co-factor	Alcohol	Aflatoxin B1[64]
Peak incidence	8th decade[65]	5th decade[57]
Stage at presentation	High chance of early stage at diagnosis[38]	Often advanced stage at presentation[3]
Surveillance	Routine; although compliance is about 12% in a study in the United States[66]	Not known and not routine
Median survival	Overall survival of > 16 mo in a study from United States[67]	Most die at initial presentation
Diagnosis	Radiological (multi-phasic dynamic CT or MRI) ± liver biopsy[68]	Tumour markers (occasionally, grey-scale ultrasound scan ± liver biopsy)[12,48]
Treatment	Curative therapies and palliative care; according to guidelines	Mainly palliative; often suboptimal

CT: Computed tomography; MRI: Magnetic resonance imaging.