Why is Hepatocellular Carcinoma Less Attributable to Viral Hepatitis in Yemen?

The hepatitis B virus (HBV) and the hepatitis C virus (HCV) are still public health problems in Yemen, witholder individuals having much higher prevalence than younger generations. However, research on the prevalenceof viral hepatitis in association with hepatocellular cancer (HCC) has not yet been undertaken in Yemen. The aimof this study was to determine the prevalence of HBV and HCV infection among HCC patients and to estimatethe risk of these infections being associated with the development of HCC. A cross-sectional study was conductedon patients attending oncology outpatient in Sana’a, Yemen, through the period 2008-mid 2010 with confirmeddiagnosis of HCC. A total of 88 cases were studied thoroughly with different investigations such as CT-scan,ultrasound, tumour marker, alpha-feto-protein and histopathological biopsy. A structured questionnaire wasalso applied and physical examination done to assess the general condition of the patients. Statistical package(SPSS version 16) was used for analysis of the data. The mean age of the cases was 61.2 years (±12.6) with halfover 60 years. There were fewer male patients (36%) compared to females and most (97%) only had basic /noformal education. Seventy nine (89%) were diagnosed as HCC cases with histopathological biopsy while therest were diagnosed by ultrasound, CT scan, tumour marker, and alpha-feto-protein. Around one-third of thesubjects were positive for HBsAg and HCV antibodies. Multivariate analysis showed infection with HCV and useof smoking was associated with HCC diagnosis. Although an association was observed between the occurrenceof HCC and viral hepatitis (either HBV or HCV) and cigarette smoking, but the rate of viral infection was lowerthan what has been reported elsewhere.