title: Primary liver cancer deaths and related years of life lost attributable to hepatitis B and C viruses in India.
abstract: OBJECTIVE
  More than 25,000 people die of liver cancer annually in India. There is little information about the contribution of hepatitis B virus (HBV) and hepatitis C virus (HCV) to these deaths. We conducted a systematic review of published studies on HBV or HCV infection and liver cancer in India and estimated the population attributable fraction (PAF) of liver cancer deaths caused by these infections and the corresponding annual number of deaths and years of life lost (YLL) in the country.
  
  
  METHODS
  We searched the PubMed and Scopus databases, as well as the reference list of relevant articles in the systematic review. For calculation of the number of liver cancer deaths attributable to HBV and HCV, we used two sources of outcome data and two relative risks for the association between HCV and liver cancer.
  
  
  RESULTS
  The PAF was 67% for HBV, 17-19% for HCV, and 71-72% for HBV and/or HCV. The annual attributable number of liver cancer deaths was approximately 17,000 for HBV; 4500 for HCV; and 18,500 for HBV and/or HCV, corresponding to approximately 297,000, 75,000, and 315,000 YLL, respectively. There was little difference in these numbers using the two sources of outcome data or the two risk estimates for HCV.
  
  
  CONCLUSIONS
  Our findings underscore the importance of primary prevention of HBV and HCV by appropriate measures, including vaccination (HBV only), prevention of transfusion-related infections, and increased awareness of the routes of transmission and long-term health outcomes.
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, United States. Electronic address: farhad.islami@cancer.org.
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.affiliation: Department of Epidemiology, Tata Memorial Hospital, Parel, Mumbai, India. Electronic address: dikshitrp@tmc.gov.in.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Dikshit
authors.affiliation: Department of Digestive Diseases, Tata Medical Center, Kolkata, India.
authors.forename: Mohandas K
authors.initials: MK
authors.lastname: Mallath
authors.affiliation: Surveillance and Health Services Research, American Cancer Society, Atlanta, United States.
authors.forename: Ahmedin
authors.initials: A
authors.lastname: Jemal
mesh_terms: D016208:Databases, Factual; D016174:Hepacivirus; D006509:Hepatitis B / Q000150:complications / Q000401:mortality*; D006515:Hepatitis B virus; D006526:Hepatitis C / Q000150:complications / Q000401:mortality*; D006801:Humans; D007194:India / Q000453:epidemiology; D008113:Liver Neoplasms / Q000209:etiology / Q000401:mortality*; D015201:Meta-Analysis as Topic; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
keywords: Hepatitis B virus; Hepatitis C virus; India; Liver cancer; Population attributable fraction