Trends in the incidence of primary liver cancer in Central Uganda, 1960–1980 and 1991–2005

Abstract

Trends in primary liver cancer (PLC) incidence rates will generally reflect temporal changes in exposure to aetiological agents. Worldwide, and in sub-Saharan Africa in particular, the great majority of PLCs are hepatocellular carcinomas (HCCs). In North America and Europe at present, HCCs are one of the few cancers observed with increasing incidence (Taylor-Robinson et al, 1997; El-Serag, 2004; West et al, 2006), largely attributed to earlier exposure to hepatitis C virus (HCV) (Davila et al, 2004). Prevalence of obesity and diabetes has also been increasing in these populations during concurrent time periods and has been suggested as another possible aetiological factor in rising HCC rates (Calle et al, 2003; El-Serag et al, 2004). However, trends in HCC rates from other regions are less clear. In particular, limited data exist from regions where HCCs is primarily attributable to chronic hepatitis B viral infection. In Asia, HCC rates may be declining (Goh, 1997; McGlynn et al, 2001). Reductions in HCC incidence among young children in Taiwan has been linked to nation-wide hepatitis B vaccination (Chang et al, 1997). In sub-Saharan Africa, hepatitis B viral infection is endemic and the attributable fraction of HCCs due to hepatitis B virus (HBV) is high (B60%) (Kirk et al, 2004; Parkin, 2006). Further, most African countries do not routinely provide or only recently initiated hepatitis B vaccination as part of their national immunisation programmes. Urbanisation, obesity, and HIV infection might also affect HCC rates in Africa. To characterise temporal trends in HCC rates within an urban African population, we evaluated cancer registry data collected in Central Uganda from 1960 through 2005.