Liver cancer risk

Preventable cases

Liver cancer cases are preventable, UK, 2015

Caused by obesity

Liver cancer cases caused by overweight and obesity, UK, 2015

 

Caused by smoking

Liver cancer cases caused by smoking, UK, 2015

 

Caused by infections

Liver cancer cases caused by infections, UK, 2015

 

The estimated lifetime risk of being diagnosed with liver cancer is 1 in 58 (2%) for males, and 1 in 122 (less than 1%) for females born after 1960 in the UK.[1]

These figures have been calculated on the assumption that the possibility of having more than one diagnosis of liver cancer over the course of a lifetime is very low (‘Current Probability’ method).[2]

References

  1. Lifetime risk estimates calculated by the Statistical Information Team at Cancer Research UK. Based on Office for National Statistics (ONS) 2016-based Life expectancies and population projections. Accessed December 2017, and Smittenaar CR, Petersen KA, Stewart K, Moitt N. Cancer Incidence and Mortality Projections in the UK Until 2035. Brit J Cancer 2016. 
  2. Esteve J, Benhamou E and Raymond L. Descriptive epidemiology. IARC Scientific Publications No.128, Lyon, International Agency for Research on Cancer, pp 67-68 1994. 

About this data

Data is for UK, past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961, ICD-10 C22.

The calculations used past and projected cancer incidence and mortality and all-cause mortality rates for those born in 1961 to project risk over the lifetime of those born in 1961 (cohort method).[1] Projections are based on observed incidence and mortality rates and therefore implicitly include changes in cancer risk factors, diagnosis and treatment.

Last reviewed:

49% of liver cancer cases in the UK are preventable.[1]

Liver cancer risk is associated with a number of risk factors.[2,3]

Liver Cancer Risk Factors

  Increases risk Decreases risk
'Sufficient' or 'convincing' evidence
  • Aflatoxins
  • Alcoholic drinks
  • Liver flukes (Clonorchis sinensis and Opisthorchis viverrini)
  • 1,2-Dichloropropane
  • Oestrogen-progestogen contraceptives
  • Hepatitis B and C viruses
  • Plutonium
  • Thorium-232 and its decay products
  • Tobacco smoking (in smokers and in smokers’ children)
  • Vinyl chloride
  • Body fatness
 
'Limited' or 'probable' evidence
  • Androgenic (anabolic) steroids
  • Arsenic and inorganic arsenic compounds
  • Betel quid without tobacco
  • DDT
  • Dichloromethane (Methylene chloride)
  • Human immunodeficiency virus (HIV) type 1
  • Schistosoma japonicum
  • Trichloroethylene
  • X-radiation, gamma-radiation
  • Coffee

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classifications.

Last reviewed:

International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] 20% of liver cancer cases in the UK are caused by smoking.[2]

Hepatocellular carcinoma (HCC) risk is 51-56% higher in current smokers compared with never-smokers, meta-analyses have shown.[3,4] HCC risk is almost 10 times higher in smokers who also heavily drink alcohol.[5] Smoking and hepatitis C virus (HCV) infection have a multiplicative effect on HCC risk.[6]

Hepatoblastoma risk is almost five times higher in children whose parents both smoked in the preconception period, a cohort study showed.[7]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

Last reviewed:

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2] 23% of liver cancer cases in the UK are caused by overweight and obesity.[3]

Liver cancer risk is 18% higher in those who are overweight (body mass index [BMI] 25-29.9) and 83% higher in those who are obese (BMI 30+), compared with those of a normal weight (BMI 18.5-24.9), a meta-analysis showed.[4] The association may be stronger for males than for females.[4]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

Last reviewed:

International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] 10% of liver cancer cases in the UK are caused by HBV or HCV infection.[2] An estimated 90% of liver cancer cases in developing countries, and 40% of cases in developed countries, are caused by hepatitis B (HBV) or hepatitis C (HCV) infection.[3]

Worldwide around 2 billion people are infected with HBV, and around 80 million with HCV.[4] Chronic infection occurs in around 10% (HBV) and 80% (HCV) of newly-infected people.[4]

Hepatocellular carcinoma (HCC) risk is around 20 times higher in people with HBV and/or HCV infection, in areas such as the UK where prevalence of infection is low.[5] HCC risk in people with HCV infection is higher among those who are older, male, or have a previous alcohol-related hospital admission, a cohort study showed.[6]

80-90% of patients with HBV- or HCV-related HCC also have cirrhosis, but HBV infection may also be associated with HCC risk in the absence of cirrhosis.[7,8]

Cholangiocarcinoma (CCA) risk is increased to a lesser extent with HBV and/or HCV infection.[9]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

References

  1. International Agency for Research on Cancer. List of Classifications by cancer sites with sufficient or limited evidence in humans, Volumes 1 to 122. Accessed October 2018.
  2. Brown KF, Rumgay H, Dunlop C, et al. The fraction of cancer attributable to known risk factors in England, Wales, Scotland, Northern Ireland, and the UK overall in 2015. British Journal of Cancer 2018.
  3. Parkin DM. The global health burden of infection-associated cancers in the year 2002. IJC 2006;118:3030-44.
  4. International Agency for Research on Cancer (IARC). World cancer report 2008. Lyon: IARC; 2008.
  5. Cho LY, Yang JJ, Ko KP, et al. Coinfection of hepatitis B and C viruses and risk of hepatocellular carcinoma: systematic review and meta-analysis. IJC 2011;128:176-84.
  6. McDonald SA, Hutchinson SJ, Bird SM, et al. A record-linkage study of the development of hepatocellular carcinoma in persons with hepatitis C infection in Scotland. BJC 2008;99:805-10.
  7. Donato F, Boffetta P, Puoti M. A meta-analysis of epidemiological studies on the combined effect of hepatitis B and C virus infections in causing hepatocellular carcinoma. IJC 1998;75:347-54.
  8. Adami HO, Hunter D, Trichopoulos D, eds. Textbook of Cancer Epidemiology. New York: Oxford University Press; 2002.
  9. Zhou Y, Zhao Y, Li B, et al. Hepatitis viruses infection and risk of intrahepatic cholangiocarcinoma: evidence from a meta-analysis. BMC Cancer 2012;12:289.
Last reviewed:

International Agency for Research on Cancer (IARC) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) classify the role of this risk factor in cancer development.[1,2] 7% of liver cancer cases in the UK are caused by alcohol drinking.[3] Almost one-third of liver cancer deaths in high-income countries are caused by alcohol.[4]

Liver cancer risk is 16% higher in people who consume 37.5g+ (4.5+ units) of alcohol per day, compared with non-drinkers, a meta-analysis showed.[5] Liver cancer risk is 2.2 times higher in people who consume 50g+ (6+ units) of alcohol per day, compared with non- or occasional drinkers, a meta-analysis showed.[6] Liver cancer risk is not associated with light or moderate  drinking (up to 4.5-6 units of alcohol per day), meta-analyses have shown.[5,6]

Hepatocellular carcinoma (HCC) risk among people with hepatitis B (HBV) or hepatitis C virus (HCV) infection is doubled in heavy drinkers compared with moderate or non-drinkers, a case-control study showed.[7]

Alcohol misuse is associated with cirrhosis, but may also cause liver cancer in the absence of cirrhosis.[5]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

Last reviewed:

Cirrhosis

Hepatocellular carcinoma (HCC) risk is 8-55 times higher in people with liver cirrhosis Open a glossary item, case-control and cohort studies show.[1-5] HCC risk is higher in HBV/HCV-related cirrhosis (accounting for 57% of cirrhosis cases worldwide[6,7]) than alcoholic cirrhosis.[8,9]

HCC risk is 19 times higher in people with a history of primary biliary cirrhosis, versus those without the condition, a meta-analysis showed.[10]

Cholangiocarcinoma (CCA) risk is ten times higher in people with cirrhosis, a case-control study showed.[10]

Non-alcoholic fatty liver disease (NAFLD)

Liver cancer risk is more than 4 times higher in people hospitalised with non-alcoholic fatty liver disease (NAFLD, related to obesity and diabetes[12]), compared with the general population, a cohort study showed.[13]

Gallstones

Liver cancer risk is 90% higher in people who have had gallstones (cholelithiasis), a meta-analysis of cohort studies showed.[14]

Diabetes

Hepatocellular carcinoma (HCC) risk is 66% higher in diabetics, a meta-analysis showed.[15] HCC risk among diabetics may be lower in metformin users, and higher in sulfonylurea or insulin users, each compared with non-users; but HCC risk is not associated with thiazolidinedione use, a meta-analysis showed.[16]

HCC risk may increase with duration of diabetes, a cohort study (mainly including men) showed.[17] HCC risk in diabetics appears to be independent of other liver cancer risk factors,[18-20] and diabetes is associated with further increased HCC risk in people with chronic liver disease, hepatitis C virus (HCV) infection, or cirrhosis.[21]

References

  1. Franceschi S, Montella M, Polesel J, et al. Hepatitis viruses, alcohol, and tobacco in the etiology of hepatocellular carcinoma in Italy. Cancer Epidemiol Biomarkers Prev 2006;15:683-9.
  2. Randi G, Altieri A, Gallus S, et al. History of cirrhosis and risk of digestive tract neoplasms. Ann Oncol 2005;16:1551-5.
  3. La Vecchia C, Negri E, Cavalieri d'Oro L, et al. Liver cirrhosis and the risk of primary liver cancer. Eur J Cancer Prev 1998;7:315-20.
  4. Persson EC, Quraishi SM, Welzel TM, et al. Risk of liver cancer among US male veterans with cirrhosis, 1969-1996. BJC 2012;107:195-200.
  5. Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127:S35-50.
  6. Perz JF, Armstrong GL, Farrington LA, et al. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.
  7. Ribes J, Cleries R, Rubio A, et al. Cofactors associated with liver disease mortality in an HBsAg-positive Mediterranean cohort: 20 years of follow-up. IJC 2006;119:687-94.
  8. Persson EC, Quraishi SM, Welzel TM, et al. Risk of liver cancer among US male veterans with cirrhosis, 1969-1996. BJC 2012;107:195-200.
  9. Fattovich G, Stroffolini T, Zagni I, et al. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology 2004;127:S35-50.
  10. Liang Y, Yang Z, Zhong R. Primary biliary cirrhosis and cancer risk: a systematic review and meta-analysis. Hepatology 2012;56(4):1409-17
  11. Welzel TM, Graubard BI, El-Serag HB, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma in the United States: a population-based case-control study. Clin Gastroenterol Hepatol 2007;5:1221-8.
  12. Sorensen HT, Mellemkjaer L, Jepsen P, et al. Risk of cancer in patients hospitalized with fatty liver: a Danish cohort study. J Clin Gastroenterol 2003;36:356-9.
  13. Singh S, Singh PP, Singh AG, et al. Anti-diabetic medications and the risk of hepatocellular cancer: a systematic review and meta-analysis. Am J Gastroenterol 2013;108(6):881-91; quiz 892.
  14. El-Serag HB, Tran T, Everhart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 2004;126:460-8.
  15. La Vecchia C, Negri E, Decarli A, et al. Diabetes mellitus and the risk of primary liver cancer. IJC 1997;73:204-7.
  16. Adami HO, Chow WH, Nyren O, et al. Excess risk of primary liver cancer in patients with diabetes mellitus. JNCI 1996;88:1472-7.
Last reviewed:

Family history

Hepatocellular carcinoma (HCC) risk is 155% higher in people with a family history of liver cancer, a meta-analysis showed.[1]

Haemochromatosis

Hepatocellular carcinoma (HCC) risk is up to 11 times higher in people with haemochromatosis Open a glossary item, compared with healthy controls, a meta-analysis showed.[2] The risk increase may be limited to specific haemochromatosis types,[2] and people with coexisting cirrhosis.[3]

Last reviewed:

International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1] Arsenic, polychlorinated biphenyls and trichloroethylene are classified by IARC as possible causes of liver cancer, based on limited evidence.[1] Less than 1% of liver cancer cases in the UK are caused by workplace exposures.[2]

UK portrait version shown here. Country versions, cancers caused by other risk factors, and landscape formats are available for free from our cancer risk publications.

Last reviewed:

International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

An estimated 2,500 liver cancer cases worldwide each year are caused by liver flukes infection;[2] infection occurs mainly in endemic regions in China and other parts of Asia.[3-5]

Last reviewed:

International Agency for Research on Cancer (IARC) classifies the role of this risk factor in cancer development.[1]

Liver cancer risk is 5-6 times higher in people with HIV/AIDS, compared with the general population, meta-analyses have shown.[2,3

Last reviewed:

Coffee consumption is classified by the World Cancer Research Fund, American Institute for Cancer Research (WCRF/AICR) as probably protective against liver cancer.[1

Liver cancer risk is 45% lower in people with the highest intake of coffee, compared with non- or occasional coffee drinkers, a meta-analysis showed.[2]

References

  1. World Cancer Research Fund / American Institute for Cancer Research. Continuous Update Project Findings & Reports. Accessed October 2018.
  2. Yu C, Cao Q, Chen P, Yang S, Deng M, Wang Y, Li L. An updated dose response meta-analysis of coffee consumption and liver cancer risk. Scientific Reports. 2016 Dec 2;6:37488.
Last reviewed:

Cancer stats explained

See information and explanations on terminology used for statistics and reporting of cancer, and the methods used to calculate some of our statistics.

Citation

You are welcome to reuse this Cancer Research UK content for your own work.
Credit us as authors by referencing Cancer Research UK as the primary source. Suggested styles are:

Web content: Cancer Research UK, full URL of the page, Accessed [month] [year].
Publications: Cancer Research UK ([year of publication]), Name of publication, Cancer Research UK.
Graphics (when reused unaltered): Credit: Cancer Research UK.
Graphics (when recreated with differences): Based on a graphic created by Cancer Research UK.

When Cancer Research UK material is used for commercial reasons, we encourage a donation to our life-saving research.
Send a cheque payable to Cancer Research UK to: Cancer Research UK, Angel Building, 407 St John Street, London, EC1V 4AD or

Donate online

Acknowledgements

We are grateful to the many organisations across the UK which collect, analyse, and share the data which we use, and to the patients and public who consent for their data to be used. Find out more about the sources which are essential for our statistics.

Rate this page:

Currently rated: 1.9 out of 5 based on 10 votes
Thank you!
We've recently made some changes to the site, tell us what you think