Liver Cancer: Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 05/2022

ON THIS PAGE: You will find out more about the factors that increase the chance of developing liver cancer and ways to lower your risk. Use the menu to see other pages.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. Knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors can raise a person’s risk of developing liver cancer. The main risks in the United States are cirrhosis of the liver and nonalcoholic fatty liver disease (NAFLD), explained below:

  • Cirrhosis. Cirrhosis develops when liver cells are damaged and replaced by scar tissue. Most cirrhosis in the United States is caused by regularly drinking too much alcohol, called alcohol abuse. Other causes are NAFLD, viral hepatitis (types B and C, as described below), too much iron in the liver from a disease called hemochromatosis, reduced blood flow to the liver from a condition called portal hypertension, and some other rare types of chronic liver disease. Combined alcohol abuse and hepatitis virus infection puts people at high risk of cirrhosis and hepatocellular carcinoma (HCC).

  • Obesity, NAFLD, and diabetes. Obesity causes fat to be deposited in the liver, which leads to NAFLD. Over the past decade, strong evidence has emerged suggesting that NAFLD and diabetes, a related disease, are increasingly important risk factors for HCC in the United States.

  • Viral hepatitis. Hepatitis viruses are viruses that infect the liver. The 2 common types are hepatitis B and hepatitis C. Viral hepatitis is the largest risk factor for liver cancer worldwide. Hepatitis C has become much more common than hepatitis B because there is no vaccine to prevent hepatitis C.

    Viral hepatitis can be passed from person to person through exposure to blood or bodily fluids. This can happen through physical injury or trauma, by sharing needles during drug use or the tattooing process, or by sexual contact. In the case of hepatitis B, an unborn baby or infant can get the virus if the mother has it. This can be avoided by vaccinating the baby.

    If you develop acute hepatitis B or C and then “clear the virus,” you recover completely from the acute infection. Only people who do not clear the virus and have a persistent infection have an increased risk. Your doctor will be able to perform blood tests that tell if you have cleared the virus.

  • Age. In the United States, adult primary liver cancer occurs most often in people older than 60.

  • Gender. Men are more likely than women to develop liver cancer.

  • Environmental factors. Some environmental factors may increase the risk of liver cancer, such as exposure to certain chemicals or eating food contaminated with aflatoxin. Aflatoxin is a toxin made by a mold that can grow on stored nuts and grains. There is less risk of this in the United States.

Risk factors are cumulative. This means that having more than 1 risk factor increases a person's risk of developing liver cancer more. For instance, a person who carries both hepatitis B and C has a higher risk than a person carrying 1 type of the virus. Similarly, a person with hepatitis C who also drinks alcohol has a higher risk.


Different factors cause different types of cancer. Researchers continue to look into what factors cause liver cancer, including ways to prevent it. Although there is no proven way to completely prevent liver cancer, you may be able to lower your risk. Talk with your doctor for more information about your personal risk of cancer.

In the United States, HCC can usually be avoided by preventing viral hepatitis and cirrhosis. A vaccine can protect healthy people from contracting hepatitis B. In fact, the U.S. Centers for Disease Control and Prevention recommends that all children should have this vaccination. There is no vaccine against hepatitis C, which is most often associated with current or previous intravenous (IV) drug abuse. Blood banks in the United States check donated blood to make sure that blood carrying the hepatitis viruses is not used.

Cirrhosis can be avoided by not abusing alcohol and preventing viral hepatitis. Most industrialized countries have regulations to protect people from cancer-causing chemicals. In the United States, such regulations have virtually eliminated these chemicals that can cause HCC.

There is increasing evidence that certain medications can control chronic hepatitis B or C infection. This can reduce the inflammation and damage these viruses cause in the liver. There have been major advances in recent years in antiviral therapy, particularly for chronic hepatitis C virus infection. This is likely to have a major positive impact on liver cancer prevention, particularly if taken before cirrhosis develops. For information about these types of treatments, it is important to talk with a hepatologist. A hepatologist is a doctor who specializes in diseases of the liver.

Because of its link to obesity, NAFLD is becoming an increasingly important risk factor for HCC. People are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, eating a balanced diet, and participating in moderate physical activity. Your doctor can help you create an appropriate exercise plan based on your needs, physical abilities, and fitness level.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.