Progress in Low-Cost Treatments for Liver Cancer

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One of the many diseases the continent of Africa struggles with is liver cancer. Until now, there were only expensive options for treatment and prevention. But researchers have come upon an easy and relatively cheap solution. Madeleine Brand talks with Dr. Sydney Speisel, a pediatrician and professor at Yale Medical School.


And now our regular look at health news. One of the many diseases Africa struggles with, liver cancer. Until now, there were only expensive options for treatment and prevention, but now researchers have discovered an easy and relatively cheap solution. I spoke about it earlier with Dr. Sidney Spiesel. He's a pediatrician and professor at Yale Medical School.

Dr. Spiesel, welcome back to DAY TO DAY.

Dr. SIDNEY SPIESEL (Pediatrician and Professor at Yale Medical School): Thank you. Hi, Madeleine.

BRAND: So what have they found causes liver cancer in humans in Africa?

Dr. SPIESEL: There are two major things. One is a poison, which is called aflatoxin, and we'll come back to that in a minute. Another very important cause, actually, is a virus infection, Hepatitis B, and in fact, the two things probably work in concert.

BRAND: And primarily it's in Africa where one finds this aflatoxin. Tell us about that.

SPEISEL: Aflatoxin is produced by a mold that lives on corn, sort of moist, under humid conditions especially. Corn, peanuts which are, outside of the United States are called groundnuts, and cottonseed. In the United States, you know, agriculture is so advanced and everything is so clean and organized that there's almost no way for this mold to grow. The peanuts are kept dry during all aspects of processing. Corn is kept dry, so the mold doesn't grow on the surface.

But you know, in many parts of Africa, the best they can do is collect these agricultural products and put them in cribs which are subject to a lot of moisture. Or put them in plastic bags and the mold grows in them. And because of that, in many parts, for example, of West Africa, if you were to just draw blood from adults and children, you'd find that more than 90% have some evidence of aflatoxin in their blood.

BRAND: So was there a solution to this? Did researchers figure out a way to prevent this spread of aflatoxin?

SPEISEL: The solution was incredibly stunning. There were some researchers at the University of Leeds in London who realized that the real problem is a storage problem, so they suggested, first of all, using the sun to fully dry peanuts and lay them out on fiber mats instead of on the ground while they're drying, before they're stored. And then taking the nuts and just sorting through them before you store them and discarding moldy or damaged ones.

And then storing them in bags made of local, natural fibers which breathe instead of plastic bags, so the humidity inside the bags was lower. And last of all, this was the expensive one, is that they supplied wooden pallets that cost about $10 a piece, that gives you an idea of the range of price we're working in, so that the peanuts were stored in their bags above the ground.

Keep in mind that this is in the context of a country in which the gross national product is only $1100 a year, so it's a big piece of cash, but it's do-able. And the difference was stunning. It was just amazing. This is something which wound up costing, for the first time around, maybe $50 for each household. Although in subsequent years these things could be reused, so the price would come down. But the effect was truly amazing in the decrease in the amount of aflatoxin detected in the blood of villagers.

BRAND: And the corresponding decrease in liver cancer?

SPEISEL: To the extent that we know that the aflatoxin causes liver cancer, I think we're all assuming that the liver cancer rate is going to be dropping dramatically in places where this intervention has been instituted.

BRAND: Dr. Sydney Speisel writes the Medical Examiner column for the online magazine Slate. He's a pediatrician and professor at the Yale Medical School. Dr. Sydney Speisel, thank you for joining us.

SPEISEL: Thank you very much.

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