STEP 1: Prevention and early detection
This step outlines recommendations for the prevention and early detection of HCC.
Evidence shows that not smoking, avoiding or limiting alcohol intake, eating a healthy diet, maintaining a healthy body weight, being physically active, being sun smart and avoiding exposure to oncoviruses or carcinogens may help reduce HCC risk (Cancer Council Australia 2018).
Timely diagnosis for viral HBV and 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.
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, older 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 co-infection, non-alcoholic fatty liver disease, type 2 diabetes, iron overload, aflatoxin exposure and tobacco smoking.
Further information
Detailed policy information on HBV and HCC is available in the liver cancer chapter of Cancer Council Australia’s National cancer prevention policy.
Everyone should be encouraged to reduce their modifiable risk factors, including avoiding alcohol and controlling or eradicating chronic viral hepatitis infections.
Coffee consumption is linked to a reduced risk of HCC (Bai et al. 2016).
There is developing evidence that low-dose aspirin and lipophilic statin use may be linked to a significantly lower risk of HCC (Li et al. 2020; Simon et al. 2020).
Australia does not have a population screening program for HCC. Patients at risk of HCC should be in a surveillance program, including patients with non-alcoholic fatty liver disease who have advanced liver disease. Patients under surveillance have their tumours detected at an earlier stage and therefore have better outcomes, including improved survival.
Follow guidelines for screening appropriate populations, which are summarised in the National Cancer Institute Liver cancer screening PDQ.
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 male patients from age 40
- Asian-background female patients from age 50
- Caucasian patients from age 50.
The most recent guidelines from the American Association for the Study of Liver Diseases recommend that HCC surveillance be based on a six-monthly liver ultrasound in high-risk groups with or without alpha-fetoprotein (AFP) (Marrero et al. 2018).
There is no evidence for more frequent ultrasounds (less than six months) or for using other imaging (CT, MRI) as a first-line screening.
Screening with AFP is widely used and included in the Australian guidelines. Changes in AFP in patients with chronic viral hepatitis in treatment or post treatment are important.
Patients who have viral chronic hepatitis and a family history of HCC have an increased risk of HCC and need to undergo six-monthly surveillance with ultrasound.
For basic information about cancer in the family, visit the Centre for Genetics Education website.
