RESUMEN
BACKGROUND & AIMS: There are conflicting data regarding the epidemiology of hepatocellular carcinoma (HCC) arising in the context of non-alcoholic and metabolic-associated fatty liver disease (NAFLD and MAFLD). We aimed to examine the changing contribution of NAFLD and MAFLD, stratified by sex, in a well-defined geographical area and highly characterised HCC population between 1990 and 2014. METHODS: We identified all patients with HCC resident in the canton of Geneva, Switzerland, diagnosed between 1990 and 2014 from the prospective Geneva Cancer Registry and assessed aetiology-specific age-standardised incidence. NAFLD-HCC was diagnosed when other causes of liver disease were excluded in cases with type 2 diabetes, metabolic syndrome, or obesity. Criteria for MAFLD included one or more of the following criteria: overweight/obesity, presence of type 2 diabetes mellitus, or evidence of metabolic dysregulation. RESULTS: A total of 76/920 (8.3%) of patients were diagnosed with NAFLD-HCC in the canton of Geneva between 1990 and 2014. Between the time periods 1990-1994 and 2010-2014, there was a significant increase in HCC incidence in women (standardised incidence ratio [SIR] 1.83, 95% CI 1.08-3.13, p = 0.026) but not in men (SIR 1.10, 95% CI 0.85-1.43, p = 0.468). In the same timeframe, the proportion of NAFLD-HCC increased more in women (0-29%, p = 0.037) than in men (2-12%, p = 0.010) while the proportion of MAFLD increased from 21% to 68% in both sexes and from 7% to 67% in women (p <0.001). From 2000-2004 to 2010-2014, the SIR of NAFLD-HCC increased to 1.92 (95% CI 0.77-5.08) for men and 12.7 (95% CI 1.63-545) in women, whereas it decreased or remained stable for other major aetiologies of HCC. CONCLUSIONS: In a populational cohort spanning 25 years, the burden of NAFLD and MAFLD associated HCCs increased significantly, driving an increase in HCC incidence, particularly in women. LAY SUMMARY: Hepatocellular carcinoma (HCC) is the most common type of liver cancer, increasingly arising in patients with liver disease caused by metabolic syndrome, termed non-alcoholic fatty liver disease (NAFLD) or metabolic-associated fatty liver disease (MAFLD). We assessed all patients with HCC between 1990 and 2014 in the canton of Geneva (western Switzerland) and found an increase in all HCC cases in this timeframe, particularly in women. In addition, we found that HCC caused by NAFLD or MAFLD significantly increased over the years, particularly in women, possibly driving the increase in overall HCC cases.
RESUMEN
Doctors are sometimes challenged with doubts and worries concerning vaccination. These doubts can come from their patients, but also from their collegues. By reviewing scientific litterature, most myths concerning vaccination can be debunked. Existing tools can guide health care professionnals who are facing these issues by providing useful information. The current system leading to licensure of vaccine can generate mistrust: continuous monitoring of eventual adverse events following immunization permits to constantly reassess the safety of the available products. Vaccines represent a powerful tool in fighting many infectious diseases. Communicating efficiently is the key to build trust and move forward in addressing doubts concerning vaccination.
Les médecins sont parfois confrontés à des doutes quant à l'utilité et l'innocuité des vaccins, émis par des patients, mais aussi par des collègues. Une revue de la littérature scientifique en lien avec certains mythes fréquemment évoqués permet de conclure le plus souvent à la sécurité des vaccins présentement disponibles. Des outils peuvent guider les professionnels de la santé confrontés à ces questions en donnant une information pertinente et critique sur la vaccination. Le système actuel de mise sur le marché des vaccins peut générer une certaine méfiance : la surveillance continue des produits vaccinaux permet de détecter d'éventuels problèmes et défauts et d'y réagir. Les vaccins restent une façon efficace de lutter contre plusieurs maladies infectieuses. Une bonne communication permet un climat de discussion et de confiance.