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Liver cancer in low and middle income countries

BMJ 2003; 326 doi: (Published 10 May 2003) Cite this as: BMJ 2003;326:994

Prevention should target vaccination, contaminated needles, and aflatoxins

  1. Andrew J Hall (, professor of epidemiology,
  2. Christopher P Wild, professor of molecular epidemiology (
  1. London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. University of Leeds, Leeds LS2 9JT

    Hepatocellular carcinoma affects more than 500 000 people globally annually, and five year mortality exceeds 95%. More than half of these people are in China, and the incidence in sub-Saharan Africa is also high.1 The causes of most of these cancers are now known, and their prevention is possible.

    More than 50% of hepatocellular carcinomas are due to persistent (as opposed to transient) hepatitis B infection, and around 25% are due to persistent hepatitis C virus.2 However, persistent hepatitis B infection occurs primarily as a result of infection in the first five years of life, whereas most hepatitis C infection occurs in adult life. Thus primary liver cancer in younger individuals (under 50 years of age) is attributable to hepatitis B in more than 75% of the patients.

    Aflatoxins are fungal toxins that commonly contaminate maize, groundnuts, and other crops. They play an important part in modifying the risk of liver cancer associated with hepatitis B. After being metabolised in the liver the toxin can bind to guanine …

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