CancerQuest | Liver Cancer: Risk Factors

Hepatitis C Virus (HCV):
For Western countries, including the U.S. infection with hepatitis C is the leading cause of both HCC and chronic liver disease. It is of special importance because unlike hepatitis B virus, there is no vaccine available for hepatitis C virus. ⁽¹⁾

Excessive alcohol intake:
Alcohol liver disease is the second most common risk factor for HCC in the U.S., after infection with hepatitis C virus.⁽²⁾

Geography:

More than 80% of HCC cases appear in Eastern Asia or sub-Saharan Africa. North and South America, Northern Europe and Oceania have much lower incidence rates. ⁽³⁾

Ethnicity:

In the United States, HCC incidence rate of Asians is twice as high as that of African Americans and four times that of whites.⁽³⁾

Sex:

Males have a higher liver cancer rate than females. The difference in the male:female ratio is greatest among Europeans. The difference between the rates is likely caused by different exposure to risk factors including alcohol consumption, cigarettes, and infection with hepatitis B virus (HBV) or hepatitis C virus (HCV). More on HBV and HCV.⁽³⁾

Age:

In developed countries (including Canada and the United States) and most Asian populations, the peak of HCC incidence rate is in people 75 years old and older. On the other hand, the peak in African men occurs between 60 and 65 years old and then decreases. The peak age for African women occurs between 65 and 70 years old and then decreases.⁽³⁾

Hepatitis B Virus (HBV):

Those who carry HBV have a 5 to 15 fold increased risk of developing HCC over the general population. Between 70 and 90% of HCCs related to the presence of HBV are diagnosed in patients that suffer from cirrhosis.

In places with high HCC incidence rates, HBV is usually transmitted from mother to child (vertical transmission), whereas in areas with low HCC incidence rates patients usually get infected with HBV through sexual and parenteral ways (horizontal transmission). ⁽³⁾

Obesity:

A 16-year period study in the United States showed a 5 fold increase in cancer mortality in people with great body mass index in contrast to those who had a normal body mass index. Liver cancer is frequently found in patients with metabolic disarrangements. ⁽³⁾

Diabetes Mellitus:

Many studies around the world have found a significant relationship between diabetes and the development of HCC. Between 10 and 20% of cirrhosis patients have overt diabetes and a higher percentage present impaired glucose tolerance. ⁽³⁾

Tobacco:

The association between smoking and HCC still is not yet clear. Studies have produced conflicting results, showing both negative and positive relationships. However, two studies focused on women both reported a positive association, so smoking may be a higher risk factor for women than men. ⁽³⁾

Exposure to aflotoxins:
Aflatoxins are a type of mycotoxin, toxic chemicals made by some types of fungi. Aflatoxin is produced by Aspergillus fungi when the fungus grows on improperly stored food products. Aflatoxins are capable of causing DNA mutations, including the tumor suppressor, TP53 (p53). Aflatoxins may be found in peanuts, tree nuts, corn, wheat and other grains, and oil seeds. ⁽⁴⁾ ⁽¹⁾