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Risk factors for liver cancer

While the exact cause of liver cancer may not be known, several factors may increase the risk of developing the disease. Because no widely recommended routine screening tests have been developed for liver cancer, people with a family history of the disease or other risk factors should talk with their doctor about steps they can take to monitor or reduce their risk. The National Comprehensive Cancer Center recommends alpha-fetoprotein blood tests and ultrasounds every six to 12 months for people with a high risk of developing liver cancer.

Risk factors for liver cancer include:


Age: In the United States, the average age at onset of liver cancer is 63 years.

Gender: Men are more likely to develop liver cancer than women, by a ratio of 2 to 1.

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 or hepatitis C virus is the most common liver cancer risk factor. These infections lead to cirrhosis of the liver. Both hepatitis B and C viruses may spread from person to person through sharing of contaminated needles (such as in drug use), unprotected sex or childbirth. The viruses may also be passed on through blood transfusion, though this risk has been greatly reduced in the United States since the start of blood testing for these viruses.

Obesity: Being obese may increase the chances of developing liver cancer, probably through development of non-alcoholic steatohepatitis (NASH) and eventually, cirrhosis.


Heavy use of alcohol: Alcohol abuse is a common cause of cirrhosis of the liver, which increases a person’s liver cancer risks.

Smoking: Tobacco use may increase the risk of developing liver cancer.

Anabolic steroids: Used by athletes to increase strength and muscle mass, the long-term use of anabolic steroids (male hormones) may 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 hepatitis B or C infections. Regular testing by the federal government 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) may increase the risk of angiosarcoma of the liver. In recent years, strict regulation on exposure to these chemicals has been imposed in the United States.

Other conditions

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 percent of the cases in the United States), people who develop HCC have underlying cirrhosis. Cirrhosis is caused by several factors. Besides alcohol abuse and chronic hepatitis B or C 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 and autoimmune diseases may cause cirrhosis.

Metabolic diseases: Certain types of inherited metabolic diseases may 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 may damage the liver and increase a person’s liver cancer risks.

Diabetes: Having diabetes may also increase the risk of developing liver cancer.

Learn more about diagnostic procedures for liver cancer

Next topic: What are the symptoms of liver cancer?

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