Mini-review Epidemiology and prevention of hepatocellular carcinoma Silvia Franceschi a, * , Syed Ahsan Raza a,b a International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon Cedex 08, France b Department of Surgery, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan article info Article history: Received 4 March 2008 Received in revised form 27 May 2008 Accepted 29 October 2008 Keywords: Hepatitis B virus Hepatitis C virus Hepatocellular carcinoma Meta-analysis Vaccine abstract A meta-analysis on the seroprevalence of hepatitis B surface antigen (HBsAg) and antibod- ies against hepatitis C virus (anti-HCV) in 27 881 hepatocellular carcinomas from 90 studies confirmed wide international variations. A predominance of HBsAg was found in hepato- cellular carcinomas from most Asian, African and Latin American countries, but anti-HCV predominated in Europe, North America, Japan, Pakistan, Mongolia, and Egypt. Anti-HCV was found more often than HBsAg in Europe and the United States. Twenty-five years after having been licensed, HBV vaccination programmes are now carried out in 158 countries, but they have yet to reach many high-risk populations in sub-Saharan Africa and Asia. In the absence of a vaccine, the prevention of HCV infection requires an integrated strategy (i.e., screening of blood donations, safe injection practices, and avoidance of unnecessary injections). Ó 2008 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Hepatocellular carcinoma (HCC) represents approxi- mately 6% of all new cancer cases diagnosed worldwide, with more than half of these occurring in China alone [1]. Relatively high incidence rates are also found in South Eastern Asia and in sub-Saharan Africa [1]. As it is one of the least curable malignancies, HCC is the third most fre- quent cause of cancer death among men worldwide [1]. Chronic infection with hepatitis B virus (HBV) and hep- atitis C virus (HCV) are the most important causes of HCC [2]. According to the World Health Organisation (WHO), approximately 350 million people are chronically infected with HBV [3], and 170 million with HCV [4] worldwide. There are no comparable statistics for the number of indi- viduals coinfected with HBV and HCV. The relative importance of HBV and HCV infections in HCC aetiology is known to vary greatly from one part of the world to another [5], and can change over time [6]. In order to elucidate prevention priorities in different parts of the world, we will examine in the present paper: (1) rel- ative predominance of HBV and HCV infection in HCC in different continents and (2) progress made in the preven- tion of HBV and HCV infection. 2. Materials and methods We have recently collated all published data on the prevalence of chronic HBV and HCV infection among HCC cases worldwide. Methods have already been reported [7]. Briefly, all studies which showed the prevalence of both hepatitis B surface antigen (HBsAg) and antibodies against HCV (anti-HCV), alone and in combination, for at least 20 HCC cases, were included. After exclusion of stud- ies using first-generation ELISA for anti-HCV testing, 90 studies with relevant data on the prevalence of HBsAg and anti-HCV, covering 27 881 HCC cases from 36 coun- tries, were available. The majority of cases were from Asia (66%) followed by the Americas (15%), Europe (12%) and Africa (7%). We have also reviewed the state of implementation of vaccination against HBV and the obstacles to the preven- tion of HCV infection in different parts of the world. 0304-3835/$ - see front matter Ó 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.canlet.2008.10.046 * Corresponding author. Tel.: +33 4 72 73 84 02; fax: +33 4 72 73 83 45. E-mail address: franceschi@iarc.fr (S. Franceschi). Cancer Letters 286 (2009) 5–8 Contents lists available at ScienceDirect Cancer Letters journal homepage: www.elsevier.com/locate/canlet