Introduction : Hepatocellular carcinoma (HCC) usually affects patients aged 50–70 years but earlier onset (25–40 years) may occur in hepatitis B endemic areas. With respect to the natural history, it takes 10 years to develop chronic hepatitis, 20 years to develop cirrhosis and 30 years to develop HCC. Thus, 70–90 % of HCC develop on a background of cirrhosis However, hepatitis B virus is directly oncogenic and can cause HCC in the absence of cirrhosis. This may represent a major cause of death from late diagnosis in resource-limited areas.

Methods : We report a case of a black African family in which clinical diagnosis of HCC was made on two male siblings in the south west region of Cameroon, W/Africa accompanied by literature search.

Results : HCC-prone families of the type reported here could provide powerful models for studying the preventive measures of a hepatitis B vaccination. It would seem prudent that hepatitis vaccination be given the highest priority to those individuals where the HCC yield is increased. The optimum timing for immunization in conjunction with the administration of hepatitis B immunoglobulin at a contralateral site is immediately after birth or within 12 h.

Conclusions : The highest risk for HCC may occur in families in which a hereditary component may be acting in concert with hepatitis B virus. We suggest a more extensive investigation of the genetic hypothesis of HCC and its fibrolamellar variant. In all cases of HCC, it is important to screen all fist degree relatives to detect early and asymptomatic disease.