Risk factors for hepatocellular carcinoma in Turkey

The contribution of hepatitis B, hepatitis C, and excess alcohol intake to the development of hepatocellular carcinoma in Turkey was assessed. The stu dy was conducted through a questionnaire sent to seven major medical referr al centers in different regions of Turkey and is based on 207 patients seen in the period 1994-1997. Of the seven centers, two were located in West Tu rkey (54 patients), two were in Central Turkey (85 patients), and two were in south and southeast Turkey (68 patients). In 196 of the 207 patients (94 .7%), there was a history of chronic liver disease, and in 180 patients (87 %) liver cirrhosis was documented, Of the 207 patients, 116 (56%) had hepat itis B, 48 (23.2%) had hepatitis C and 33 (15.9%) had a history of excess a lcohol intake. Anti-delta testing was available in 69 of 116 patients with hepatitis B, and anti-HDV was positive in 13 of these patients (13/69, 18.8 %). Of the 33 patients with a history of heavy alcohol intake, 18 had conco mitant chronic viral hepatitis infection, and alcohol alone was the etiolog y of hepatocellular carcinoma in only 15 cases (7.2%). The distribution of etiologic factors was not homogenous in different geographical regions ill Turkey. In central, south, and southeastern Turkey, the predominant etiolog y of hepatocellular carcinoma was hepatitis B, whereas in western Turkey th e impact of hepatitis B, hepatitis C, and alcohol was similar. This study i ndicates that hepatitis B virus infection is the leading cause of hepatocel lular carcinoma in Turkey, followed by hepatitis C infection and alcoholic liver disease.