title: Epidemiologic risk factors of hepatocellular carcinoma in a rural region of Egypt.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is a major health problem worldwide, including Egypt. In the recent past, HCC has become the second most prevalent cancer among men in Egypt. Since HCC has not been well studied in the rural population of Egypt, this case-control study was conducted to investigate the epidemiologic risk factors of HCC in the predominantly rural region of Gharbiah, Egypt.
  
  
  METHODS
  A total of 150 cases and 150 controls matched to cases on age (±5 years) and sex were recruited from the Gharbiah Cancer Society and Tanta Cancer Center. Exposure data were collected by an interviewer-administered standardized questionnaire about epidemiologic, occupational, medical and family history of HCC. Conditional logistic regression was utilized to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CI). The effect modification of HCC risk between viral infection and environmental risk factors was also assessed.
  
  
  RESULTS
  Being an industrial worker was an independent risk for developing HCC (OR 3.54, 95% CI 1.18, 10.63) after adjusting for viral infection, schistosomiasis and tobacco smoking. High relative risk of HCC was observed among HCV-infected individuals who were farmers (OR 9.60, 95% CI 3.72, 24.76), industrial workers (OR 12.90, 95% CI 4.33, 38.43) or active smokers (OR 5.95, 95% CI 2.20, 16.08).
  
  
  CONCLUSIONS
  Occupational exposure may play an important role in the development of HCC. Farming, industrial exposures and cigarette smoking may increase the risk of HCC among HCV-seropositive individuals. Future research focusing on mechanisms of occupational exposures among HCV patients in this population is needed.
authors.forename: Amr S
authors.initials: AS
authors.lastname: Soliman
authors.forename: Chu-Wei
authors.initials: CW
authors.lastname: Hung
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsodikov
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Seifeldin
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ramadan
authors.forename: Dina
authors.initials: D
authors.lastname: Al-Gamal
authors.forename: Emily L
authors.initials: EL
authors.lastname: Schiefelbein
authors.forename: Priyanka
authors.initials: P
authors.lastname: Thummalapally
authors.forename: Subhojit
authors.initials: S
authors.lastname: Dey
authors.forename: Kadry
authors.initials: K
authors.lastname: Ismail