Risk Factors for Hepatocellular Carcinoma in India

Abstract

Hepatocellular carcinoma (HCC) is an important cause of death all over the world, more so in Asia and Africa. The representative data on epidemiology of HCC in India is very scanty and cancer is not a reportable disease in India and the cancer registries in India are mostly urban. 45 million people who are suffering from chronic Hepatitis B virus (HBV) infection and approximately 15 million people who are afflicted with chronic Hepatitis C virus (HCV) infection in India. HBV and HCV infection is considered an important etiologic factor in HCC. Positive association between HCC and consumption of alcohol where alcohol contribute as a cofactor for hepatotoxins and hepatitis viruses. Aflatoxin contamination in the diets, Hepatitis B virus infection and liver cirrhosis in Andhra Pradesh, India and direct chronic exposure to aflatoxins was shown to cause liver cirrhosis. Cirrhosis of liver of any cause lead to develop about 70%-90% of HCC. Aflatoxin interact synergistically with Hepatitis B virus (HBV)/Hepatitis C virus (HCV) infection which increase the risk of HCC. HBV infection, HBV infection with Aflatoxin exposure, viral infection and alcohol consumption leading to overt cirrhosis of the liver, alcohol consumption leading to cirrhosis of the liver with viral infection are the predominant risk factor for the development of HCC. HCV and alcohol are also associated with HCC in India. Indians develop diabetes at younger age, Asians have strong genetic susceptibility for type II diabetes. Diabetes mellitus is identified as a risk factor for HCC. Prevention of viral infection by universal vaccination against hepatitis virus, HCC surveillance program, preventing alcoholic liver diseases, fungal contamination of grains and ground crops to prevent basically Aflatoxin exposure are important measures to prevent liver diseases and HCC among those at risk. ( J CLIN EXP HEPATOL 2014;4:S34-S42)

Incidence and mortality of liver cancer and their relationship with the human development index in the world

“…Incidence and mortality of liver cancer in the word important factors such as smoking, alcohol, and infected injection (Franceschi and Wild, 2013;Kar, 2014). In examining the relationship between the life expectancy of the HDI, an inverse relationship was observed between the component with rates of incidence and mortality.…”

“…HCG differences in the incidence rates in different geographical areas are correlated with hepatitis B and C rates because chronic viral hepatitis has been reported as an important risk factor for HCC in endemic areas (Chisari et al, 1989;Colombo et al, 1989;Idilman et al, 1998). This is despite the fact that approximately 45 million and 15 million people worldwide suffer from chronic hepatitis B and C (Kar, 2014). Another reason for the difference in incidence in different regions was Human papillomavirus (HPV), which is responsible for stomach, liver and cervical cancers (Vineis and Wild, 2014).…”

A Review on Dietary and Non-Dietary Risk Factors Associated with Gastrointestinal Cancer

“…A good percentage of alcoholics were known to develop cirrhosis, which in turn developed into liver cancer. Alcohol has cocarcinogenic properties in the pathogenesis of liver cancer, and it can influence on P450 mixed function oxidase system, thus causing enhanced activation of chemical carcinogens [49,50]. A study conducted in South Africa by Mandishona E, et al among black Africans revealed that the dietary iron overload may elevate the risk of liver cancer.…”

Vaccination Age Changing from Infancy and Childhood to Adolescence and Adulthood: An In-Dispensable Approach in Immunization Programs

“…For instance, Hepatitis C virus, alcohol consumption and overweight in Japan [103], hepatitis C virus, alcohol consumption and aflatoxins in India [104] and aflatoxins in sub-Saharan Africa and Asia [105] have been reported as other important risk factors of HCC.…”