Risk factors for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the second most common cause of death from cancer worldwide. The vast majority of cases occur in the setting of cirrhosis, usually due to hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. In developed countries, chronic alcohol abuse is a significant risk factor for advanced liver disease and HCC; in addition, in Western countries obesity and diabetes are growing epidemics, which significantly contribute to the development of non-alcoholic fatty liver disease (NAFLD). NAFLD is an emerging risk factor for cirrhosis and HCC. Metabolic liver diseases, in particular hereditary hemochromatosis, account for a small number of liver cancers. In several regions of the world, including sub-Saharan Africa, Eastern Asia and parts of South America, aflatoxin exposure in food is a significant risk factor for HCC. Unlike other cancers, risk factors for HCC can usually be identified at an individual level; moreover, the majority of risk factors are preventable. Vaccination against HBV is the most efficient primary prevention measure available in high-incidence countries, whereas antiviral treatment for HBV and HCV may reduce liver disease progression and the risk of HCC. Lifestyle modification, including weight loss and promotion of physical exercise, may have a significant impact in the management of NAFLD and its complications, including HCC.