Among US Medicare recipients, metabolic disorders contribute more to the incidence of hepatocellular carcinoma (HCC) incidence than any other risk factor, including hepatitis C virus (HCV) infection, alcohol, and smoking, a study published in the journal Cancer has shown.1

The incidence of HCC has been increasing in the United States for many decades. Because the incidence of HCV infection has been declining and the prevalence of metabolic disorders has been rising, researchers hypothesized that the proportion of HCC attributable to certain risk factors may be changing.

For the study, researchers analyzed data from 10 708 patients with HCC diagnosed between 2000 and 2011 and included in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. These patients were compared with 332 107 cancer-free controls.

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Results showed that 32% of HCC cases were attributable to metabolic disorders, 20.5% to HCV infection, 13.4% to alcohol, 9% to smoking, 4.3% to hepatitis B virus (HBV) infection, and 1.5% to genetic disorders.

Researchers found that the impact of risk factors on the incidence of HCC varied by race/ethnicity and sex. HCC was more likely to be attributable to metabolic disorders among Hispanics and whites, while HCV had the largest effect among blacks and Asians.

Further, the study demonstrated that HCC cases attributed to metabolic disorders increased by approximately 10%, while HCC cases attributable to alcohol-related disorders and HCV infection remained stable.


1. Makarova-Rusher OV, Altekruse SF, McNeel TS, et al. Population attributable fractions of risk factors for hepatocellular carcinoma in the United States [published online ahead of print March 21, 2016]. Cancer. doi:10.1002/cncr.29971.