Global and country underestimation of hepatocellular carcinoma (HCC) in 2012 and its implications.
OBJECTIVE
The problems of screening costs, as well as poor data, potentially lead to the underestimation of the incidence of hepatocellular carcinoma (HCC). In particular, this is problematic in developing countries with limited resources and poor data. The study develops a model to inform policy makers of the true incidence and potential extra cost of HCC in a developing country context.


METHODS
Using Globocan 2012 data, we employed an ecological correlation design at country level to associate HCC incidence data with relevant determinant data like HBV-HCV and other exposure factors. A Poisson regression model was used to estimate potentially missed incident cases of HCC by country and region based on the country risk factor covariate values.


RESULTS
The results indicated that HBV and HCV prevalence were significantly associated with HCC incidence (p<0.001) and potentially accounted for 94%% of incident HCC in 2012. We estimated a total of 120,772 potentially missed incident HCC cases in 2012. These cases are largely predicted for South Asia (>21,000), North Asia (>15,000), Western Africa (14,500) and Eastern Africa (12,500).


CONCLUSIONS
Developing countries, with poorer quality data and a high historical burden of hepatitis, were predicted to have the majority of missed HCC cases in 2012 based on our model. These countries are, therefore, less able to detect, budget for or manage HCC. The high cost of HCC treatment, as well as its economic implications, poses a challenge in resource poor settings.
Faculty of Commerce, University of the Witwatersrand, Johannesburg, South Africa; Public Health Medicine, School of Nursing and Public Health, University of the Kwazulu-Natal, Durban, South Africa; SAMRC/UKZN Gastrointestinal Cancer Research Centre, South Africa. Electronic address: Kurt.Sartorius@wits.ac.za.
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Sartorius
Public Health Medicine, School of Nursing and Public Health, University of the Kwazulu-Natal, Durban, South Africa; SAMRC/UKZN Gastrointestinal Cancer Research Centre, South Africa.
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B
Sartorius
School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa(1); SAMRC/UKZN Gastrointestinal Cancer Research Centre, South Africa.
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C
Aldous
School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa(1); SAMRC/UKZN Gastrointestinal Cancer Research Centre, South Africa.
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PS
Govender
School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa(1); SAMRC/UKZN Gastrointestinal Cancer Research Centre, South Africa.
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TE
Madiba
D006528:Carcinoma, Hepatocellular / Q000453:epidemiology*; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors
Alcohol; Determinants; Hepatitis B and C; Hepatocellular (liver) carcinoma; Incidence; Spatial risk; Under-reporting