Primary liver cancer--the potential for prevention and elimination

Primary liver cancer (PLC) is one of the top ten cancers in the world, and a leading cause of cancer mortality in Singapore and the Asia Pacific region. Chronic hepatitis B infection accounts for at least 80% of primary hepatocellular cancer. Other chemical carcinogens, such as aflatoxins, have been identified in foodstuffs and have also been found in the urine of normal human subjects. Aflatoxin and other chemical carcinogens, e.g. alcohol, cigarettes, also pose serious risks of hepatocarcinogenesis. Identification of small tumours (not necessarily early) may allow for earlier treatment to be instituted. Capsular lesions in general have a better prognosis than infiltrating cancers. In Singapore, if hepatitis B virus can be eliminated by the year 2000, at least 65% of hepatitis B related deaths can be saved. This would involve large scale hepatitis B immunisation to prevent the carrier state and the use of antiviral drugs earlier to eliminate hepatitis B infections.