Hepatocellular carcinoma in a rural population at risk

This study of hepatocellular carcinoma in a homogeneous rural Transkeian population at high risk consisted of: evaluation of liver biopsies of 246 patients with hepatocellular carcinoma using routine histology and immunoperoxidase for HBV stains; collection of reliable data on alcohol consumption, blood HBsAg and ALT status in asymptomatic controls from an adequate population sample; assessment of maize intended for human consumption for contamination by carcinogenic fungi. Tumour histology of rural Blacks did not differ from those described in other studies. Cirrhotic livers were present in 45.1% and iron overload in 68% of cases. Tissue HBsAg was detected in 57% (45% of non-cirrhotic and 59% of cirrhotic livers). Asymptomatic controls showed 9.5% of HBsAg positivity, 3.5% had elevated ALT and 41.3% admitted to alcohol abuse. Maize had insignificant contamination by Aspergillus flavus and very frequent contamination by Fusarium moniloforme. This study suggests a multifactorial aetiology of hepatocellular carcinoma, with viral infection being of the most importance.