Hepatitis B is leading to an increase in the cases of liver cancer in Uganda but this can be reduced by vaccination.
According to the World Health Organisation (WHO) between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies like vaccination.
Hepatitis B is a liver infection caused by a virus. It is spread through body fluids such as blood and semen. It is the most common live infection in the world according to the US Center for Disease Control and Prevention. The infection which can be prevented through immunization is the most common cause of liver cancer according to experts.
A study carried out by John Hopkins University and Makerere University shows that in Uganda liver cancer is primarily caused by hepatitis B. The study referred to as the African Liver Cancer Study had over 700 liver cancer patients and persons not suffering from the disease but who love lifestyles that expose them to the disease.
Findings from the study show that; 45 percent of liver cancer patients had hepatitis B while 5 percent had hepatitis C. Alcohol contributed to 15 percent of the cases, while other factors like diabetes, obesity, smoking, and use of drugs led to 32 percent of the cases.
Prof Ponsiano Ocama, a lead investigator of the study says that in many low-income countries like Uganda, hepatitis B and not alcohol are the biggest causes of liver cancer.
“In less developed countries the main cause of liver cancer is hepatitis B which goes untreated while in more developed countries it’s things to do with metabolic-related conditions,” he said. Other causes of liver cancer are alcohol consumption, diabetes, use of drugs, smoking, and obesity.
According to Prof Ocama, liver cancer is common among men compared to women. Many cases are diagnosed with the disease at the age of 35. He says in developing countries like Uganda, many of the cases are discovered when the disease is in the terminal stage and more than 95 percent of the cases succumbed to the disease in the first 3 three months after diagnosis.
According to figures from the Ministry of Health in 2019, the prevalence of liver cancer in the country stood at 12.2 percent. Dr. Noleb Mugisha, the head of the Comprehensive Community Cancer Program at the Uganda Cancer Institute says many people in the communities do not seek treatment early for this type of cancer because little is known about it.
“In the communities where we go, many people know about breast and cervical cancer but not cancer of the liver which leads to many patients getting treatment late. By the time they suspect it is cancer, the disease has spread and little can be done for them,” Dr Mugisha said.
Data published by the World Health Organization estimates that a total of 1,522 people succumbed to liver cancer in 2020. Many liver cancer patients develop the disease when they are young.
To reduce the number of persons who succumb to the disease annually, the Minister of Health, Dr. Jane Ruth Aceng 2019 announced that the country was going to start vaccinating children against Hepatitis B during the African Hepatitis Summit.
However, to date, the vaccine is not part of the routine immunization schedule. Dr. Immaculate Ampaire, the deputy programme manager of the Uganda National Expanded Programme on Immunization(UNEPI) says the vaccine is only available in private hospitals.
“Private hospitals have it because they normally follow WHO recommendations but government is yet to start offering the shots. We have not yet begun immunizing against it in routine immunization but talks to that effect have begun. Discussions are ongoing to agree on institutional requirements in terms of finance and other infrastructure that would be needed to start carrying it out,” she said.