Although HLA-linked hemochromatosis greatly increases the risk for hep
atocellular carcinoma in people of European ancestry, iron overload in
Africa is not thought to be etiologically related to this malignancy,
To determine if African iron overload may be associated with hepatoce
llular carcinoma, we reviewed 320 consecutive diagnostic liver biopsie
s processed at the University of Zimbabwe from 1992 to 1994 and we sel
ected for analysis 215 biopsies from adults that were suitable for the
histological assessment of hepatocellular iron. Subjects were stratif
ied according to hepatocellular iron grades of 0-2+ (normal levels to
mild siderosis; n=183) and grades of 3+ and 4+ (distinctly elevated le
vels consistent with iron overload; n=32). Thirty-six subjects had hep
atocellular carcinoma. Logistic regression modeling revealed a signifi
cant association between iron overload and hepatocellular carcinoma af
ter adjustment for age, sex and and the presence of portal fibrosis or
cirrhosis (p=0.041). The odds of hepatocellular carcinoma in subjects
with iron overload was 3.1 (95% confidence interval of 1.05-9.4) time
s that of subjects without iron overload, While we could not test for
exposure to viral hepatitis or to aflatoxins in this study, our findin
gs suggest that iron overload may be a risk factor for hepatocellular
carcinoma in Africa.