title: Reasons why West Africa continues to be a hotbed for hepatocellular carcinoma.
abstract: Hepatocellular carcinoma (HCC) exhibits a huge disease burden on West Africa, with a large proportion of all HCC cases worldwide occurring in the sub-region. The high HCC prevalence is due to the endemicity of a number of risk factors, most notably hepatitis B, C and HIV. West African HCC also displays a poor prognosis. Generally speaking, this is owing to more aggressive tumours, late patient presentation and inadequate management. Exposure to chronic viral hepatitis, more carcinogenic West African strains of hepatitis B virus and carcinogens such as aflatoxin B1 all encourage tumour growth. Lack of patient confidence in the healthcare system contributes to poor health-seeking behaviors and management of the disease can be lacking, due in part to poor health infrastructure, resources available and lack of access to expensive treatment. There is also much we do not know about West African HCC, especially the effect rising obesity and alcohol use may have on this disease in the future. Suggestions for improvement are discussed, including surveillance of high-risk groups. Although there is much to be done before West African HCC is thought to be a curable disease, many steps have been taken to move in the right direction.
authors.affiliation: Department of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom.
authors.forename: Joshua
authors.initials: J
authors.lastname: Tognarelli
authors.affiliation: Department of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom; Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria; Digestive Diseases Unit, Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Nimzing G
authors.initials: NG
authors.lastname: Ladep
authors.affiliation: Department of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom; Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Mary M E
authors.initials: MM
authors.lastname: Crossey
authors.affiliation: Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Edith
authors.initials: E
authors.lastname: Okeke
authors.affiliation: Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Mary
authors.initials: M
authors.lastname: Duguru
authors.affiliation: Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria.
authors.forename: Edmund
authors.initials: E
authors.lastname: Banwat
authors.affiliation: Department of Medicine, Imperial College London, St Mary's Campus, London, United Kingdom.
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
keywords: Aflatoxin; hepatitis B; hepatitis C; hepatocellular carcinoma; liver cancer