Cirrhosis and hepatocellular carcinoma at primary hospitals in sub-Saharan Africa: the opportunity of PEN-Plus br

We read with interest the report by C Wendy Spearman and colleagues 1 Spearman CW Dusheiko G Jonas E et al. Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan Africa. Lancet Gastroenterol Hepatol. 2022; 7: 1036-1048 Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar on the challenges and recommendations to improve screening and surveillance for hepatocellular carcinoma in sub-Saharan Africa. 1 Spearman CW Dusheiko G Jonas E et al. Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan Africa. Lancet Gastroenterol Hepatol. 2022; 7: 1036-1048 Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar The high mortality caused by cirrhosis and hepatocellular carcinoma in this region, most often a result of chronic viral hepatitis, is undoubtedly alarming. 2 GBD 2017 Cirrhosis CollaboratorsThe global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020; 5: 245-266 Summary Full Text Full Text PDF PubMed Scopus (596) Google Scholar As highlighted by Spearman and colleagues, 1 Spearman CW Dusheiko G Jonas E et al. Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan Africa. Lancet Gastroenterol Hepatol. 2022; 7: 1036-1048 Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar although primary prevention remains paramount, reducing mortality caused by hepatocellular carcinoma in this region will require improved screening and surveillance in patients with advanced fibrosis. However, many parts of sub-Saharan Africa do not have the platforms at primary and secondary health-system levels to provide the longitudinal services required for severe, complex chronic conditions such as cirrhosis, and once diagnosed, patients are rarely engaged in routine care. Hepatocellular carcinoma: measures to improve the outlook in sub-Saharan AfricaHepatocellular carcinoma is a leading public health concern in sub-Saharan Africa, and it is most prevalent in young adults (median 45 years [IQR 35–57]). Overall, outcomes are poor, with a median survival of 2·5 months after presentation. Major risk factors for hepatocellular carcinoma are hepatitis B virus (HBV), hepatitis C virus, aflatoxin B1 exposure, and alcohol consumption, with metabolic dysfunction-associated fatty liver disease slowly emerging as a risk factor over the past few years. Crucially, these risk factors are preventable and manageable with effective implementation of the HBV birth-dose vaccination, treatment of chronic viral hepatitis, provision of harm reduction services, and by decreasing aflatoxin B1 exposure and harmful alcohol consumption. Full-Text PDF