Clinical, pathologic, and etiologic heterogeneity in hepatocellular carcinoma: Evidence from Southern Africa

in Hepatocellular Carcinoma: Evidence from Southern AfricaHepatocellular carcinoma (HCC) does not present clinically in a uniform way in all parts of the world.The occurrence and presentation of HCC range from a rare and relatively benign tumor to a very common and utterly devastating tumor.So great is the difference in the character of HCC between the two extremes, which are epitomized by North Americans or Europeans on one hand and Mocambican Shangaans on the other, as to suggest the possibility of different etiologies, if not different diseases.The pattern of HCC in southern Africa embraces the whole spectrum of the disease and provides a unique opportunity to study this tumor and, in particular, its etiology.Striking differences exist between the black and white populations with regard to the occurrence of HCC: the white population has the same low incidence of the tumor and shares the same characteristics as patients in the United States, Western Europe, or Australia, whereas rural blacks are commonly afflicted with HCC and the disease occurs in its most fulminant form.With progressive urbanization of the black population, differences in the character of HCC are becoming apparent between urban and rural blacks.Our experience with this tumor in Johannesburg, South Africa is based on blacks who come from rural areas of various countries in southern Africa, particularly Mocambique, Transkei, Malawi, Botswana, and South Africa, to work in the South African gold mines, urban blacks who have lived in Johannesburg or Soweto for most of their lives (and sometimes from birth), and urban whites.INCIDENCE HCC is common throughout sub-Saharan Africa and probably affects all of the indigenous peoples, although not to the same extent (1-4).The tumor is most prevalent in southern Africa, especially in Mocambique.Mocambican Shangaan males have an age-standardized incidence rate of 103.8 per 100,000 per annum (2, 3, 5), and HCC accounts for 65.5% of all cancers in men and 31% of This work was supported by the National Cancer Association of South Africa and the South African Chamber of Mines.