Abstract
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.
Keywords
hepatocellular carcinoma - epidemiology - Africa - HBV/HCV/HIV/ aflatoxin coinfections
- iron overload
