Intended for healthcare professionals

Rapid response to:


Liver cancer in low and middle income countries

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

Rapid Response:

Role of Oncological Terrain in Cancer Prevention.


More than half of people with hepatocellular carcinoma (more than 500.000
cases globally annually with a five year mortality exceeding 95%) are
notoriously in China. Andrew J Hall and Christopher P Wild state in their
article (1): “The causes of most of these cancers are now known, and their
prevention is possible”. My first question: “In whom hepatocellular
carcinoma primary prevention has to be performed? For instance, in “all”
Chinese individuals?”. In additon, the same authors, in agreement with
others, continue: “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”. It is plain that some, but “not
all” subjects , who suffered from such as infectious viral disease,
present hepatocellular carcinomas(75% of diseased subjects present HC: it
is too much in my 46-year-long clinical experience!). Certainly, I agree
with the autors on the fact that “Preventing infection (i.e., Hepatitis B
vaccination) with these two hepatitis viruses is one key strategy to
reduce the burden of liver cancer”.

However, I like to put my third, and
least, but not last, question: “Who must undergo to hepatitis – B, C –
vaccination in order to prevent cancer?” In my opinion, Primary Prevention
of the most common and dangerous human pathologies, including
hepatocellular carcinoma, depends mainly by easy and quick bed-side
detecting individuals at "real" risk, e.g., of cancer (See,,
as well as, Oncological Terrain,
Oncogenesis, three articles: Biophysical-Semeiotic Constitutions) (2, 3,
4). To define clinically a particular constitution, which does not exclude
the presence of others, it is necessary to think over the current
possibility of gathering at the bed-side "biophysical-semeiotic" data,
providing biological and molecular-biological information on the various
human organs, tissues and apparatus, so that doctor can describe numerous
types of constitutions, even from the quantitative point of view. Without
any doubt, these data can not be observed at all by the aid of traditional
physic semeiotics, unable of carrying molecular-biological events to
clincal dimension, which really represents the most original and fertile
aspect of Biophysical Semeiotics. In conclusion, we must recognize, at
first, individual involved by “Oncological Terrain”, i.e., “Oncological
Constitution”, and then localized precisely the real risk of cancer in a
quantitative way, so that the prevention can be perform in individuals
clinically (i.e., on very large scale) and rationally selected, regardless of
the level of country income.

Sergio Stagnaro MD.,Member NYAS.

1) Hall AJ., Wild CP.Liver cancer in low and middle income countries
Prevention should target vaccination, contaminated needles, and aflatoxins
BMJ 2003;326:994-995 ( 10 May ).

2) Stagnaro-Neri M., Stagnaro S. Cancro della Mammella: Prevenzione
Primaria e Diagnosi clinica precoce con la Percussione Ascolata. Gazz.
Med. It-Arch. Sci.Med. 152, 447-457, 1993.

3) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica
condizione necessaria non sufficiente della oncogenesi. XI Congr. Naz.
Soc. It. di Microangiologia e Microcircolaz. Abstracts, pg 38, 28
Settembre-1 Ottobre, Bellagio,1983

4) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. Una
Patologia Mitocondriale Ignorata. Gazz Med. It. – Arch. Sci. Med. 144,
423, 1985 (Infotrieve)

Competing interests:  
None declared

Competing interests: No competing interests

09 May 2003
Sergio Stagnaro
Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics.
Via Erasmo Piaggio N° 23/8. 16037 Riva Trigoso (Genoa) Italy.