Liver Cancer Risk Factors
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What Are the Risk Factors for Liver Cancer?
Anything that increases your chance of getting liver cancer is a risk factor. In the United States, the average age at onset of liver cancer is 63 years. Men are more likely to develop liver cancer than women, by a ratio of 2 to 1.
Aside from age and gender, liver cancer risk factors include:
- Race and ethnicity – In the United States, liver cancer rates are highest in Asian Americans and Pacific Islanders. White Americans have the lowest risk for liver cancer. Chronic infection with Hepatitis B virus (HBV) or Hepatitis C virus (HCV) is the most common liver cancer risk factor. These infections lead to cirrhosis of the liver (see below). Both hepatitis B and C viruses can spread from person to person through sharing of contaminated needles (such as in drug use), unprotected sex, or childbirth. They can also be passed on through blood transfusion; however, this risk has been minimized in the United States since the start of blood testing for these viruses.
- Heavy use of alcohol – Alcohol abuse is a common cause of cirrhosis of the liver (see below), which increases a person’s liver cancer risks.
- Cirrhosis of the liver – Cirrhosis occurs when liver cells become damaged and are replaced by scar tissue. People with cirrhosis have an increased risk of liver cancer. In most cases (up to 90% of the cases in the U.S.), people who develop HCC have underlying cirrhosis. There are several possible causes of cirrhosis. Besides alcohol abuse and chronic HBV or HCV infections, non-alcoholic steatohepatitis (NASH, a fatty liver disease often seen in obese people who consume little or no alcohol), certain types of inherited metabolic diseases (see below), and autoimmune diseases can cause cirrhosis.
- Metabolic diseases – Certain types of inherited metabolic diseases can cause cirrhosis and increase the chances of developing liver cancer. Genetic hemochromatosis (an iron-overload disorder that builds up iron stores throughout the body including the liver), tyrosinemia (elevated levels of the amino acid tyrosine), alpha-1-antitrypsin deficiency, porphyria cutanea tarda (deficiency in heme synthesis), glycogen storage disease, and Wilson disease (elevated levels of copper in the liver) are rare diseases that can damage the liver and increase a person’s liver cancer risks.
- Diabetes – Having diabetes can also increase the risk of developing liver cancer.
- Obesity – Being obese can increase the chances of developing liver cancer, probably through development of NASH and eventually, cirrhosis.
- Anabolic steroids – Used by athletes to increase strength and muscle mass, the long-term use of anabolic steroids (male hormones) might slightly increase the risk of developing liver cancer. Cortisone-like steroids such as hydrocortisone, dexamethasone, and prednisone do not carry the same risk.
- Arsenic – Chronic exposure to naturally occurring arsenic through drinking water (contaminations in some wells) increases the risk of developing some forms of liver cancer.
- Aflatoxins – These are cancer-causing substances made by a fungus that contaminates wheat, corn, soybeans, rice, and some types of nuts. Contamination usually occurs due to storage of the food stuff in a moist, warm environment, more common in warmer and tropical countries. Long-term exposure to aflatoxins is a major liver cancer risk factor, especially in people with HBV or HCV infections. Regular testing by the US-FDA regulates the content of aflatoxins in foods in the United States.
- Exposure to certain chemicals – Exposure to vinyl chloride (a chemical used in the making of some plastics) and thorium dioxide (a chemical previously used for x-ray testing) can increase the risk of developing angiosarcoma of the liver. In recent years, strict regulation on exposure to these chemicals has been imposed in the U.S.
In addition to the list above, some factors, like use of tobacco or oral contraceptives, might increase liver cancer risk. Research is ongoing to determine their role, if any, in liver cancer.
NOTE: Anything that increases your risk of getting a disease is called a risk factor. Having one or more risk factors for liver cancer does not mean that you will get cancer. Not having liver cancer risk factors doesn’t mean that you will not get cancer. If you think you may be at risk, you should discuss it with your doctor.
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