Hepatocellular Carcinoma in Africa: Epidemiology, Prevention and Outcomes

Purpose of review: This review synthesizes the current knowledge of hepatocellular carcinoma (HCC) epidemiology across Northern and sub-Saharan Africa. We examine how causes of HCC differ by region, highlight prevention and early detection strategies, and identify gaps in treatment and palliative care to improve outcomes. Recent findings: The causes of HCC vary markedly across the continent. HCV predominates in Northern Africa, whereas HBV infection and dietary aflatoxin exposure prevail in sub-Saharan Africa. Rising obesity, diabetes, harmful alcohol use, and hepatitis D co-infection are important but under-researched contributors. Most patients still present with advanced disease, fewer than 6% receive curative therapy, median survival is measured in months, and access to palliative care remains dismal. Summary: HCC poses a major challenge in Africa, marked by high incidence, early age at diagnosis, and among the worst survival outcomes worldwide. Primary prevention through HBV birth-dose vaccination, aflatoxin mitigation, and population-level HCV treatment offers the most effective way to reduce mortality, yet implementation barriers persist.