Reply to: "Challenges associated with the roll-out of HCC surveillance in sub-Saharan Africa - the case of Uganda".
Reply to: "Challenges associated with the roll-out of HCC surveillance in sub-Saharan Africa - the case of Uganda".
复制标题
回复：“在撒哈拉以南非洲开展 HCC 监测所面临的挑战 - 以乌干达为例”。
DOI：
10.1016/j.jhep.2020.07.003
复制
发表时间：
2020
影响因子：
25.7
通讯作者：
Nahon,Pierre
中科院分区：
文献类型：
--
作者：
Singal,AmitG;Lampertico,Pietro;Nahon,Pierre
We read with great interest the letter from Dr. Van Hees and colleagues describing the current status and challenges of hepatocellular carcinoma (HCC) surveillance in resource-limited areas, including parts of sub-Saharan Africa. 1 We commend our colleagues for initiating these important efforts, particularly given the continued high burden of HCC in these areas. In their survey of HCC surveillance capacity in Ugandan institutions, the authors found each had ultrasound availability, with most having multiple ultrasound machines and trained personnel. Although this availability provides a foundation for HCC surveillance programs, data from the Western world have highlighted that this is essential but not sufficient, with continued underuse of surveillance in clinical practice. 2 In addition to providers reporting competing clinical concerns, patient-reported barriers such as transportation and costs are associated with lower surveillance receipt. 3 These patient-and provider-level barriers may be even more prevalent in resource-limited countries and would need to be aggressively addressed. Interventions such as reminder systems for providers and population health strategies for patients can significantly increase HCC surveillance receipt but have not been evaluated in routine clinical practice or resource-limited settings. 2 Although advances in surveillance biomarkers offer promise for improved effectiveness of early detection efforts, studies will be needed to assess their effectiveness in areas such as sub-Saharan Africa as only 2 of the 5 centers had consistent access to AFP testing.Surveillance fits in a larger screening context and mortality reduction is dependent on timely follow-up of abnormal screening results and treatment of detected HCC lesions. A large study encompassing 1,315 patients from 8 African countries excluding Egypt demonstrated less than 3% of patients received any HCC specific treatment, 4 regardless of their eligibility for curative procedures. This finding reflects that implementation of HCC surveillance programs in sub-Saharan Africa will not be successful if not conducted in parallel with improvement in access to HCC treatment. Challenges to HCC treatment in this region include a shortage of dedicated physicians as well as
