Although liver cancer has a relatively low incidence in the United
States, compared with other cancers, it is 10 times more common in many
developing countries than in this country. The incidence of liver cancer
is highest in sub-Saharan Africa, China, southern Asia, and Japan.
One of the most common forms of liver cancer, hepatocellular carcinoma,
has been closely linked to the hepatitis B virus (HBV). The association
between seropositivity for hepatitis B and the presence of hepatocellular
carcinoma is strongest for children; almost 100% of children who have
hepatocellular carcinoma test positive for the hepatitis B surface antigen
(HBsAg). In contrast, 70% to 80% of adults with hepatocellular carcinoma
are seropositive for hepatitis B.
The incidence of liver cancer is particularly high in Taiwan.
Hepatocellular cancer ranks among the leading causes of morbidity and
mortality: 1,000 people die of liver cancer and cirrhosis in Taiwan each
year. Three million, or 15% of the population, are afflicted with cirrhosis
and liver cancer.
There is also a high incidence of hepatitis B in Taiwan. Twenty years
ago, the carrier rate of hepatitis B reached an estimated 15% to 20% of the
general population of 21 millionone of the highest rates of hepatitis B
Although the causal relationship between hepatitis B and hepatocellular
cancer has never been established, public health officials in Taiwan and
China instituted a nationwide hepatitis B vaccination program to decrease
the incidence and carrier rate of hepatitis B, and, hopefully,
simultaneously decrease the incidence of hepatocellular cancer.
Seventeen years after the initiation of the program, the prevalence of
hepatitis B and the incidence of hepatocellular carcinoma in children age 6
to 14 years have decreased considerably.
Hepatitis B is transmitted from one person to another by blood
transfusion, contaminated needle, sexual contact, and childbirth. More than
40% of infants born to HBsAg carrier mothers become HBsAg carriers
themselves, indicating the frequent occurrence of mother-to-newborn
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Ms. Gibbons, Ms. Newlin, and Ms. Phan are project managers, Northwestern
University Medical School. Dr. Bennett is professor of medicine, Northwestern
University Medical School, Robert H. Lurie Comprehensive Cancer Center, and
director of HSR&D, VA Chicago Health Care SystemLakeside Division.