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 immunization 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][54][55] The American Association for the Study of Liver Diseases (AASLD) also recommends HBV immunization 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.[56] Family screening, early diagnosis, and correction of iron overload to prevent liver fibrosis in patients with hemochromatosis 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.[57] 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 minimize the risk of cirrhosis and consequent HCC development. They should be counseled 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]
The table that follows summarizes recommendations for primary prevention of HCC taken from the AASLD practice guidance on prevention, diagnosis, and treatment of HCC.[3]
Note that an individual patient may fall into more than one group and so interventions might be additive; please review all population and subpopulation groups to assess all that apply.
Neonate
All
Intervention
Hepatitis B vaccination
The recommended schedule depends on birthweight and HBV risk.
See Hepatitis B.
Goal
Reduce risk of HCC in adults via lifelong immunity against hepatitis B infection
Hepatitis B vaccination has been shown to significantly reduce the risk of HCC.
Adult
At risk; unvaccinated against hepatitis B infection
Goal
Reduce risk of HCC via immunity against hepatitis B infection
Hepatitis B vaccination has been shown to significantly reduce the risk of HCC.
With HBV or HCV infection
Intervention
Antiviral treatment for HBV or HCV
Give antiviral treatment to all patients who meet criteria for treatment according to AASLD guidance.
See Hepatitis B.
See Hepatitis C.
Goal
Reduce risk of HCC
Suppression of HBV and eradication of HCV infection decrease the risk of developing HCC.
With chronic liver disease
Intervention
Lifestyle measures
Encourage patients with chronic liver disease to abstain from alcohol and tobacco use.
Counsel about maintaining a healthy weight, balanced diet, and managing comorbidities.
Consider recommending coffee consumption, however data are insufficient regarding a specific dose.
Advise patients to avoid exposure to aflatoxins (e.g., contaminated peanuts) and aristolochic acid (e.g., in some herbal medicines).
Goal
Reduce risk of cirrhosis
Cirrhosis, of any etiology, is present in 80% of patients with HCC and the annual risk of developing HCC in these patients is approximately 2%. Risk factors are often synergistic.
Alcohol may be a cause of cirrhosis but is also a cofactor increasing the risk of HCC up to fivefold in people with cirrhosis of other etiologies.
Smoking is associated with a 20% to 86% increased risk of HCC.
Obesity and metabolic syndrome components (including diabetes) independently increase HCC risk. Weight loss alone has not been shown to reduce HCC risk, although it does improve metabolic dysfunction-associated steatotic liver disease and fibrosis outcomes. Physical activity may be beneficial in HCC prevention, independent of any associated weight loss.
≥1 cup of coffee a day is dose-dependently associated with a significant reduction in HCC risk. Additives such as sugar and cream should be avoided.
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][148][149][150]
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 immune globulin and nucleoside/nucleotide analog to reduce the risk of graft infection and to prevent recurrence of HCC. However, there is good evidence showing that newer-generation nucleoside/nucleotide analogs with very low risk of resistance are effective in preventing graft hepatitis without the use of hepatitis B immune globulin, leading to excellent long-term outcomes.[151]
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