title: Geoepidemiology of hepatocellular carcinoma in the island of Crete, Greece. A possible role of pesticides.
abstract: OBJECTIVE
  Geoepidemiological data of hepatocellular carcinoma (HCC) are lacking. Crete has a genetically homogeneous population and is suitable for studies to identify a possible contribution of environmental factors in HCC.
  
  
  METHODS
  Databases for HCC (316 cases), hepatitis B virus (HBV) (633) and hepatitis C virus (HCV) (392), constructed over the past 20 years in our Unit, were used. Data included place of birth and place of residence for the last 15 years. Hellenic Statistical Authority provided population statistics from 1980 to 2014. Time-spatial methods were applied in Gis-ArcMap 10 software. Spatial autocorrelation tests (Moran's index) detected differences between the spatial distribution to place of residence. Spatial density maps were created. Kriging Interpolation was applied, to produce prediction maps of HCC.
  
  
  RESULTS
  Hepatitis C virus appears in areas of high prevalence while HBV is uniformly distributed. HCC is more prevalent in Eastern Crete. A spatial autocorrelation between HCC and either HCV (Moran's I = 0.88, P < 0.001) or HBV (I = 0.84, P < 0.02) was found as expected. However, there is a discrepancy in the South East of Crete, where a higher prevalence of HCC than expected was observed. This is an area where extensive use of pesticides in large green houses is practiced.
  
  
  CONCLUSIONS
  Hepatocellular carcinoma is associated with the dispersion of HCV and HBVs. In an area with widespread use of pesticides, a higher than expected spatial distribution of HCC was detected.
authors.affiliation: Department of Social Science, Medical School, University of Crete, Crete, Greece.
authors.forename: Dimitra
authors.initials: D
authors.lastname: Sifaki-Pistolla
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Spyridon A
authors.initials: SA
authors.lastname: Karageorgos
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Mairi
authors.initials: M
authors.lastname: Koulentaki
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Samonakis
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Soultana
authors.initials: S
authors.lastname: Stratakou
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Digenakis
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital of Heraklion, Crete, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Kouroumalis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006115:Greece / Q000453:epidemiology; D006306:Health Surveys; D006509:Hepatitis B / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008113:Liver Neoplasms / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D010575:Pesticides / Q000009:adverse effects*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D010575:Pesticides
keywords: HBV; HCV; geoepidemiology; hepatocellular carcinoma