Letters to the editor
On the risk of further excluding outcast patient populations in South America
Eloy Ruiza,b, Ramiro Fernándeza,b, Francisco Berrospia, Sandro Casavilca-Zambranob,c,d, Juan Contreras-Mancillab,d, Juan Pablo Cerapiob,e, Pascal Pineaub,f, Stéphane Bertanib,g,
Corresponding author
a Departamento de Cirugía en Abdomen, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
b International Joint Laboratory of Molecular Anthropological Oncology (LOAM), INEN, IRD, Lima, Peru
c Departamento de Patología, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
d Biobanco de Tejidos Tumorales, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
e UMR 1037 CRCT, Université de Toulouse, INSERM, UPS, Toulouse, France
f Unité Organisation Nucléaire et Oncogenèse, INSERM, Institut Pasteur, Paris, France
g UMR 152 PHARMADEV, Université de Toulouse, IRD, UPS, Toulouse, France
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Enfermedades Neoplásicas (INEN), Lima, Peru" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Biobanco de Tejidos Tumorales, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru" "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "UMR 1037 CRCT, Université de Toulouse, INSERM, UPS, Toulouse, France" "etiqueta" => "e" "identificador" => "aff0005" ] 5 => array:3 [ "entidad" => "Unité Organisation Nucléaire et Oncogenèse, INSERM, Institut Pasteur, Paris, France" "etiqueta" => "f" "identificador" => "aff0006" ] 6 => array:3 [ "entidad" => "UMR 152 PHARMADEV, Université de Toulouse, IRD, UPS, Toulouse, France" "etiqueta" => "g" "identificador" => "aff0007" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0001" class="elsevierStylePara elsevierViewall">It is with great interest that we read the article by Farah and colleagues on the epidemiological transition at work regarding risk factors for hepatocellular carcinoma (HCC) in South America <a class="elsevierStyleCrossRef" href="#bib0001">[1]</a>. In this study, the authors compiled data from 339 patients seen between 2019 and 2021 in six countries of the region, with Peruvian patients accounting for the most significant proportion, i.e., 125 HCC cases (37%) collected at one general services hospital. The results suggest a rise in HCCs associated with non-alcoholic fatty liver disease (37%) at the regional level, whereas infection with the hepatitis B virus (HBV) tends to decrease as an associated risk factor for HCC in South America (12%). However, our experience at the National Cancer Institute of Peru (INEN), the country's main specialist cancer hospital, gives a contrasting picture of HCC epidemiology in Peru and may provide deeper insights into the real socio-epidemiological situation at the regional level. Due to the multi-tiered health systems in Peru and South America, it is unlikely that data from a single center per country can provide an accurate picture of HCC epidemiology and its risk factors. For example, INEN treats more socially marginalized people (ca. 120 HCC patients/year) while representing a larger fraction of the country's population <a class="elsevierStyleCrossRef" href="#bib0002">[2]</a>, many of whom are of Native ancestry, in comparison to the gentrifying population living in metropolises and having the benefit of health insurance <a class="elsevierStyleCrossRef" href="#bib0003">[3]</a>. Our team has published a series of articles that shed light on the elevated ratio of HBV-related HCC (81.5%) in the patient population treated at INEN [<a class="elsevierStyleCrossRef" href="#bib0004">4</a>,<a class="elsevierStyleCrossRef" href="#bib0005">5</a>]. Intriguingly, HBV infection in these patients is associated with a very low viral DNA burden, disclosing a significant rate of occult infections (33.8%) with HBV sub-genotype F1b, only detectable by ultra-sensitive molecular tests <a class="elsevierStyleCrossRef" href="#bib0004">[4]</a>. Furthermore, we identified through integrative genomic analysis a distinct molecular subtype of HBV-associated HCC with ancestry-related molecular traits [<a class="elsevierStyleCrossRef" href="#bib0006">6</a>,<a class="elsevierStyleCrossRef" href="#bib0007">7</a>]. Such higher prevalence rates of occult infection with autochthonous HBV clades (F, G, H) have been documented to a great extent in Latin American patients <a class="elsevierStyleCrossRefs" href="#bib0008">[8–12]</a>, stressing the need for precautions when identifying risk factors for HCC in the region <a class="elsevierStyleCrossRef" href="#bib0013">[13]</a>. Another issue concerning the study by Farah and colleagues is the data collection period between 2019 and 2021 amid the COVID-19 pandemic. Indeed, cancer patients originating from remote and underserved regions, which correspond in Peru with areas where HBV is highly endemic <a class="elsevierStyleCrossRef" href="#bib0014">[14]</a>, could not reach metropolitan health centers during the COVID-19 lockdowns <a class="elsevierStyleCrossRef" href="#bib0015">[15]</a>, creating thereby the possibility of recruitment bias in the collection of data. We understand that the article by Farah and colleagues has particular relevance for health policymakers in South America, who could then be deterred from persisting in their efforts to combat hepatitis B. Therefore, it appears of the utmost importance for decision-making to provide a truly comprehensive overview of the HCC epidemiology in the region by considering all published literature, in order to prevent further exclusion from cancer control programs of populations already among the most deprived in South America.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "[1]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changing epidemiology of hepatocellular carcinoma in South America: A report from the South American liver research network" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M Farah" 1 => "C Anugwom" 2 => "JD Ferrer" 3 => "EL Baca" 4 => "AZ Mattos" 5 => "JPP Possebon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.aohep.2022.100876" "Revista" => array:3 [ "tituloSerie" => "Ann Hepatol" "fecha" => "2023" "volumen" => "28" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "[2]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An atypical age- specific pattern of hepatocellular carcinoma in Peru: A threat for Andean populations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S Bertani" 1 => "P Pineau" 2 => "S Loli" 3 => "J Moura" 4 => "M Zimic" 5 => "E Deharo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0067756" "Revista" => array:5 [ "tituloSerie" => "PLoS ONE" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "e67756" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23840771" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "[3]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Social exclusion and universal health coverage: Health care rights and citizen-led accountability in Guatemala and Peru" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J Samuel" 1 => "W Flores" 2 => "A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 21 | 3 | 24 |
| 2024 September | 20 | 4 | 24 |
| 2024 August | 16 | 8 | 24 |
| 2024 July | 14 | 1 | 15 |
| 2024 June | 20 | 6 | 26 |
| 2024 May | 10 | 3 | 13 |
| 2024 April | 8 | 4 | 12 |
| 2024 March | 34 | 5 | 39 |
| 2024 February | 20 | 5 | 25 |
| 2024 January | 13 | 4 | 17 |
| 2023 December | 8 | 1 | 9 |
| 2023 November | 8 | 5 | 13 |
| 2023 October | 12 | 6 | 18 |
| 2023 September | 13 | 3 | 16 |
| 2023 August | 14 | 3 | 17 |
| 2023 July | 11 | 0 | 11 |
| 2023 June | 12 | 0 | 12 |
| 2023 May | 10 | 2 | 12 |
| 2023 April | 22 | 3 | 25 |
| 2023 March | 28 | 1 | 29 |
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