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Hepatocellular carcinoma is a leading public health concern in sub-Saharan Africa, and it is most prevalent in young adults (median 45 years [IQR 35-57]). Overall, outcomes are poor, with a median survival of 2·5 months after presentation. Major risk factors for hepatocellular carcinoma are hepatitis B virus (HBV), hepatitis C virus, aflatoxin B1 exposure, and alcohol consumption, with metabolic dysfunction-associated fatty liver disease slowly emerging as a risk factor over the past few years. Crucially, these risk factors are preventable and manageable with effective implementation of the HBV birth-dose vaccination, treatment of chronic viral hepatitis, provision of harm reduction services, and by decreasing aflatoxin B1 exposure and harmful alcohol consumption. Primary prevention is central to the management of hepatocellular carcinoma, especially in poorly resourced environments. Effective screening and surveillance programmes with recall policies need to be implemented, because detection and curative management of hepatocellular carcinoma is possible if it is detected at an early stage, even in countries with minimal resources, with appropriate upskilling of medical personnel. The establishment of centres of excellence with advanced diagnostic and therapeutic capabilities within countries should improve hepatocellular carcinoma outcomes and assist in driving the implementation of much needed systematic data systems focused on hepatocellular carcinoma to establish the accurate burden in sub-Saharan Africa. Such data would support the public health importance of hepatocellular carcinoma and provide a strong basis for advocacy, programme development, resource allocation, and monitoring of progress in reducing mortality.

Background Not much is known about the information preferences of individuals at risk for cancer in sub-Saharan Africa. Clinicians exercise great autonomy in how, when, and to whom they disclose patients’ medical diagnosis and prognostic status. We sought to investigate the information preferences with regards to cancer diagnosis and prognosis of a cross-section of Ghanaians living in and outside of Ghana. Methods We surveyed a general population of Ghanaians aged ≥ 18 years old, living in and outside of Ghana about their cancer information preferences. Survey questions were developed using Qualtrics software and deployed via WhatsApp mobile app. After initial pilot to assess for feasibility and cultural relevance, initial links were distributed through social and medical contacts who were then asked to share widely with their social contacts. Participant characteristics were reviewed and their association with cancer information needs evaluated with logistic regression analysis. Results Of the four hundred and twenty-six participants who responded to the survey, 33.1% were female. Majority of respondents (81.9%) were living in Ghana at time of survey. Four hundred and twelve (96.7%) patients would like to know from their provider if they were diagnosed with cancer. The most common information need of participants was treatability/curability (92%) of the cancer. A worry about impact of cancer on family was the most common reason for not wanting any information. Univariate analysis did not identify any factors associated with reduced cancer information needs. Conclusions The overwhelming majority of Ghanaians surveyed would like to know if they were diagnosed with cancer. It is imperative that clinicians tell Ghanaians about their cancer diagnosis and share all pertinent information with them.

Hepatocellular Carcinoma Occurs at an Earlier Age in Africans, Particularly in Association With Chronic Hepatitis B