Prevention

Timely diagnosis for viral hepatitis B (HBV) and C (HCV) can reduce the risk of infection developing into cancer. Vaccination is the best prevention for HBV. Strategies to curb alcohol intake and reduce obesity (and hence type 2 diabetes and non-alcoholic fatty liver disease) will also reduce future HCC burden.

Risk factors

The major risk factors for developing HCC are:

• cirrhosis of the liver of any cause
• history of moderate to heavy alcohol intake
• obesity
• HBV infection (particularly for those with an extended period of exposure, childhood-acquired and high viral load, increasing age, ethnicity (African, Asian or Aboriginal) and male gender).

The risk factors for developing HCC in people with HCV are:

• chronic HCV infection with advanced fibrosis
• a family history of HCC.

Other risk factors for HCC include male gender, increasing age, HBV and HCV viral co-infection, non-alcoholic fatty liver disease, type 2 diabetes, iron overload, aflatoxin exposure and tobacco smoking.

Screening recommendations

Australia does not have a population screening program for HCC. Base surveillance for HCC in high-risk groups on 6-monthly liver ultrasound with or without alpha-fetoprotein (AFP).

All patients with cirrhosis should be in a screening program. In patients with HBV (without cirrhosis), screening should begin according to the following guide:

• African-background patients from age 20
• Asian-background males from age 40
• Asian-background females from age 50
• Caucasian patients from age 50.

Family history

Patients who have chronic viral hepatitis or a family history of HCC have an increased risk of HCC and need to undergo regular 6-monthly surveillance with ultrasound.

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