Primary prevention
At least 70% of HCC cases in the US could potentially be prevented through the elimination of risk factors, such as excess body weight, HBV and HCV infections, and heavy alcohol consumption.[2]
HBV immunisation is recommended for all children and adults at risk of infection with HBV, which will help prevent the development of chronic hepatitis-associated HCC.[3][55][56] The American Association for the Study of Liver Diseases (AASLD) also recommends HBV immunisation for all newborns.[3]
Prevention of HCV infection can be achieved by screening blood donors, universal precautions against blood contamination in healthcare settings, curing patients living with HCV, and the reduction of HCV transmission from injection drug use.[57] Family screening, early diagnosis, and correction of iron overload to prevent liver fibrosis in patients with haemochromatosis are important measures to prevent HCC in this patient group.
One retrospective study found that the use of low-dose aspirin was associated with a significantly lower risk of HCC and liver-related mortality in patients with chronic viral hepatitis compared with patients who did not have a history of aspirin use. Risk of gastrointestinal bleeding did not differ significantly between those who took aspirin and those who did not.[58] The AASLD advises against the use of aspirin to reduce HCC risk, unless prescribed for the treatment of other indication.[3]
Patients with chronic liver disease should receive timely appropriate treatment and be encouraged to abstain from alcohol and tobacco, and to avoid exposure to aflatoxins (e.g., contaminated peanuts) and aristolochic acid (e.g., in some herbal medicines) to minimise the risk of cirrhosis and consequent HCC development. They should be counselled about maintaining a healthy weight and managing comorbidities so as to reduce the risk of developing HCC.[3]
Some reports have also suggested that coffee consumption may decrease the risk of developing HCC; however, the preparation and quantity that is most beneficial is unclear.[3]
Secondary prevention
There is strong evidence that effective antiviral therapy to control HBV or HCV infection substantially reduces (but does not abolish) HCC risk.[3][144][145][146]
Patients with HBV- or HCV-related chronic liver disease should be considered for specific treatment of their underlying disease after resection or liver transplantation to prevent recurrence of HCC. Patients who receive liver transplantation for HBV-related HCC should continue to have hepatitis B immunoglobulin and nucleoside/nucleotide analogue to reduce the risk of graft infection and to prevent recurrence of HCC. However, there is good evidence showing that newer-generation nucleoside/nucleotide analogues with very low risk of resistance are effective in preventing graft hepatitis without the use of hepatitis B immunoglobulin, leading to excellent long-term outcomes.[147]
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