DIETARY IRON OVERLOAD AS A RISK FACTOR FOR HEPATOCELLULAR-CARCINOMA IN BLACK-AFRICANS

Although the iron-loading disease, hereditary hemochromatosis, has a s trong causal association with hepatocellular carcinoma (HCC), the carc inogenic potential of dietary iron overload in Black Africans is not k nown. We investigated this potential by evaluating iron status, alcoho l consumption, markers for hepatitis B (HBV) and C virus (HCV) infecti ons, and exposure to dietary aflatoxin B-1 in 24 rural patients with t his tumor, 48 race-, sex-, and age-matched hospital-based controls, an d 75 related or unrelated close family members of the cancer patients. Iron overload was defined as a raised serum ferritin concentration in combination with a transferrin saturation greater than or equal to 60 %, and was confirmed histologically when possible. Among 24 patients a nd 48 hospital controls, the risk of developing HCC in the iron-loaded subjects was 10.6 (95% confidence limits of 1.5 and 76.8) relative to individuals with normal iron status, after adjusting for alcohol cons umption, chronic HBV and HBC infections, and exposure to aflatoxin B-1 , The risk of HCC in subjects with HBV infection was 33.2 (7.2, 153.4) (odds ratio [95% confidence limits]), HCV infection 6.4 (0.3, 133.5), and alcohol consumption 2.0 (0.5, 8.2), Aflatoxin B-1 exposure did no t appear to increase the risk of HCC. The population attributable risk of iron overload in the development of HCC was estimated to be 29%, A mong 20 cancer patients and 75 family members, the risk of developing HCC with iron overload was 4.1 (0.5, 32.2), We conclude that dietary i ron overload may contribute to the development of HCC in Black African s.