Hepatocellular Carcinoma in Africa: Epidemiology, Prevention and Outcomes

This review synthesizes the current knowledge of hepatocellular carcinoma (HCC) epidemiology across Northern and sub-Saharan Africa. We examine how causes of HCC differ by region, highlight prevention and early detection strategies, and identify gaps in treatment and palliative care to improve outcomes.

The causes of HCC vary markedly across the continent. HCV predominates in Northern Africa, whereas HBV infection and dietary aflatoxin exposure prevail in sub-Saharan Africa. Rising obesity, diabetes, harmful alcohol use, and hepatitis D co-infection are important but under-researched contributors. Most patients still present with advanced disease, fewer than 6% receive curative therapy, median survival is measured in months, and access to palliative care remains dismal.

HCC poses a major challenge in Africa, marked by high incidence, early age at diagnosis, and among the worst survival outcomes worldwide. Primary prevention through HBV birth-dose vaccination, aflatoxin mitigation, and population-level HCV treatment offers the most effective way to reduce mortality, yet implementation barriers persist.