Materiały źródłowe

• #1 Prevention of Hepatocellular Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5040884/

  The epidemiology of hepatocellular carcinoma (HCC) has significantly changed throughout the past decade and will continue to do so in the future as a consequence of effective primary prevention and treatment of virus-related liver diseases. […] The knowledge about risk factors for HCC provides the opportunity and chance for the development and implementation of preventative strategies aiming at an efficient and effective prevention of HCC to decrease the worldwide burden of the disease. […] Primary prevention focuses on risk factors for HCC and their treatment at an early stage, secondary prevention concentrates on the treatment of underlying liver diseases in patients with HCC aiming at a prevention of disease progression, and tertiary prevention aims at a reduction of recurrence after successful curative treatment of HCC.

• #1 Prevention of Hepatocellular Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5040884/

  To prevent the complications of chronic HBV infection, the World Health Organization (WHO) recommends to include hepatitis B vaccination in routine immunization services in all countries. […] A universal hepatitis B vaccination program has been implemented in 47 of 53 European countries. […] Another essential strategy to prevent HCC related to chronic viral hepatitis is testing blood products for HBV and HCV as well as adoption of universal precautions to avoid transmission of blood-borne viruses in healthcare settings. […] Effective antiviral treatment of HBV reduces the risk of HCC. […] After curative treatment for HBV-related HCC, controlling viral status seems to be important to prevent HCC recurrence and improve survival. […] Education programs, needle and syringe exchange programs, safe injecting rooms, and special programs are therefore important measures in the primary prevention of HCV-related HCC but have not satisfactorily shown to be effective.

• #1 Prevention of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023918/

  Hepatocellular carcinoma (HCC) is considered to be one of the major malignant diseases in the world today. […] Thus, it is obvious that so prevalent is HCC, particularly in populous low-income countries, and so poor are the results of treatment when the tumor is symptomatic, that prevention of HCC is an urgent priority. […] Primary prevention is, at least theoretically, the most effective form of cancer prevention. […] Given that oncogenic hepatitis viruses contribute to the development of 75-80% of global HCC, prevention of these chronic infections would have a huge impact on the global occurrence of the tumor. […] HBV vaccine can rightfully claim to be the first 'anti-cancer vaccine. […] The introduction of HBV vaccine into the EPI in most countries and the beneficial effect this has already had in reducing viral carriage rates and the occurrence of HCC in vaccinated children is undoubtedly the most promising and far-reaching development in the prevention of this tumor and indeed, indirectly, other virally induced tumors.

• #1 Can Liver Cancer Be Prevented? | American Cancer Society

  https://www.cancer.org/cancer/types/liver-cancer/causes-risks-prevention/prevention.html

  Many liver cancers could be prevented by reducing exposure to known risk factors for this disease. […] Preventing hepatitis B (HBV) and C (HCV) infections […] The US Centers for Disease Control and Prevention (CDC) recommend that all children and adults up to age 59, as well as older adults at risk for HBV, get the HBV vaccine to reduce their risk of chronic hepatitis B and liver cancer. […] If a person has a chronic HBV or HCV infection, treatment can help slow liver damage and reduce their risk of developing liver cancer. […] Drinking alcohol can lead to cirrhosis, which in turn, can lead to liver cancer. Not drinking alcohol or drinking in moderation could help lower your risk of liver cancer. […] Staying at a healthy weight might be another way to lower your risk of liver cancer. […] Certain inherited diseases can cause cirrhosis of the liver, increasing a persons risk for liver cancer. Finding and treating these diseases early in life could lower this risk.

• #1 Liver Cancer Causes, Risk Factors, and Prevention – NCI

  https://www.cancer.gov/types/liver/what-is-liver-cancer/causes-risk-factors

  The following are protective factors for liver cancer: […] Getting the hepatitis B vaccine: Preventing HBV infection (by being vaccinated for HBV as a newborn) has been shown to lower the risk of liver cancer in children. It is not yet known if being vaccinated lowers the risk of liver cancer in adults. […] Getting treatment for chronic hepatitis B infection: Treatment options for people with chronic HBV infection include interferon and nucleos(t)ide analog therapy. These treatments may reduce the risk of developing liver cancer. […] Reducing exposure to aflatoxin B1: Replacing foods that contain high amounts of aflatoxin B1 with foods that contain a much lower level of the poison can reduce the risk of liver cancer.

• #1 Liver (Hepatocellular) Cancer Prevention (PDQ®) – NCI

  https://www.cancer.gov/types/liver/hp/liver-prevention-pdq

  Interventions With Adequate Evidence of Decreased Risk of HCC: […] HBV vaccination […] Based on solid evidence, neonatal HBV vaccination or catch-up vaccination at young ages reduces HCC incidence in young adults. […] Treatment for chronic HBV infection […] Based on solid evidence, chronic HBV treatment with nucleos(t)ide analogue therapy reduces the risk of HCC. […] Availability of food not contaminated with aflatoxin B1 […] Based on solid evidence, replacement of food highly contaminated with aflatoxin B1 with food that harbors much lower levels of aflatoxin B1 leads to a reduction in liver cancer mortality. […] Interventions With Inadequate Evidence of Decreased Risk of HCC: […] HCV treatment with direct-acting antivirals (DAAs) […] Based on fair evidence, HCV treatment with DAAs that results in sustained virological response (SVR) may reduce HCC risk. […] Statin use among adults with HBV or HCV […] Based on fair evidence, statin use may be associated with a reduced risk of developing HCC in patients with HBV or HCV infection.

• #1 Prevention of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023918/

  Because the full beneficial effects of immunization against HBV will not be felt for many years and there is no early prospect of a vaccine against HCV, other methods of preventing the spread of these viruses must continue to be rigidly enforced in an attempt to prevent HCC induced by these viruses. […] Preventing HCV and HBV infections in illicit drug users remains a difficult and sometimes contentious issue. […] Contamination of staple foodstuffs by AFB1 does not occur in industrialized countries because those foodstuffs that might be affected are screened for their aflatoxin content by governmental agencies and do not enter the market if unacceptably high levels are found. […] Attempts at primary prevention need to be focused on minimizing both sources of fungal contamination and AFB1 production.

• #1

  https://journals.lww.com/hep/fulltext/2023/12000/aasld_practice_guidance_on_prevention,_diagnosis,.27.aspx

  HBV vaccination has also been shown to significantly reduce HCC risk, so this should be performed in all newborns as well as high-risk adults who failed to undergo vaccination at birth. […] Public health policies and interventions should be implemented to address the significant mortality of HCC in the United States. […] Vaccination for HBV infection should be given in all newborns as well as high-risk adults who failed to receive vaccination at birth to reduce the risk of HCC. […] Antivirals should be given in all patients who meet criteria for treatment according to AASLD Guidance documents for HBV and HCV infection. In patients with chronic viral hepatitis, suppression of HBV and eradication of HCV infection decreases the risk of HCC development. […] Patients with chronic liver disease should be counseled to maintain a healthy weight, have a balanced diet, avoid tobacco and alcohol, and achieve adequate control of comorbid conditions including components of the metabolic syndrome. A healthy lifestyle has multiple benefits and may decrease HCC risk.

• #1 Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma

  https://www.mdpi.com/2077-0383/13/22/6770

  A comprehensive approach combining medical interventions, lifestyle changes, and environmental controls is essential for effectively decreasing HCC incidence globally. Implementing these combined measures could significantly reduce the global burden of HCC. […] Vaccination against HBV is one of the most effective primary prevention measures for HCC. Universal HBV vaccination programs have significantly reduced the prevalence of HBV infection and the incidence of HBV-related HCC, particularly in endemic regions. […] Antiviral therapies for chronic HBV infection aim to suppress viral replication, reduce liver inflammation, and prevent progression to cirrhosis and HCC. […] Chronic alcohol intake is a well-established risk factor for HCC, as it leads to liver cirrhosis and promotes carcinogenesis through mechanisms such as oxidative stress, inflammation, and impaired immune surveillance.

• #1 Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma

  https://www.mdpi.com/2077-0383/13/22/6770

  Obesity and metabolic syndrome are associated with MASLD, which can progress to metabolic dysfunction-associated steatohepatitis (MASH) and subsequently increase the risk of HCC. Engaging in regular physical activity and maintaining a healthy body weight have been shown to reduce hepatic fat accumulation, improve insulin sensitivity, and decrease liver inflammation, thereby lowering the risk of HCC development. […] Aflatoxin B1, produced by Aspergillus species and primarily transmitted through contaminated food, is a significant risk factor for HCC in developing countries. Strategies to reduce aflatoxin exposure—such as improving agricultural practices, ensuring proper food storage, and utilizing processing methods to prevent fungal contamination—have been effective in decreasing HCC incidence.

• #1

  https://journals.lww.com/hep/fulltext/2023/12000/aasld_practice_guidance_on_prevention,_diagnosis,.27.aspx

  Coffee consumption may be recommended for patients with chronic liver disease, as it has associated with decreased risk of HCC development. […] AASLD does not advise use of other chemoprevention therapies such as statins, aspirin, and metformin solely to reduce HCC risk, despite some evidence of risk reduction.

• #1 Coffee, including caffeinated and decaffeinated coffee, and the risk of hepatocellular carcinoma: a systematic review and dose–response meta-analysis | BMJ Open

  https://bmjopen.bmj.com/content/7/5/e013739

  Increased consumption of caffeinated coffee and, to a lesser extent, decaffeinated coffee are associated with reduced risk of HCC, including in pre-existing liver disease. […] An extra two cups per day of coffee was associated with a 35% reduction in the risk of HCC (RR 0.65, 95%CI 0.59 to 0.72). […] An extra two cups of caffeinated and decaffeinated coffee (2 and 3 cohort studies, respectively) were associated with reductions of 27% (RR 0.73, 95%CI 0.63 to 0.85) and 14% (RR 0.86, 95%CI 0.74 to 1.00) in the risk of HCC. […] The association was also not significantly different for the main exposures for HCC: high alcohol consumption, smoking, high BMI, T2DM and HBV/HCV. […] Our findings suggest a central role for caffeine, given that the association was weaker for decaffeinated coffee. […] This is the strongest evidence to date of an association between decaffeinated coffee and HCC. […] Randomised trials should investigate the effectiveness of increasing coffee consumption in those at risk of HCC including patients with existing CLD.

• #1 Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma

  https://www.mdpi.com/2077-0383/13/22/6770

  Aspirin demonstrates its chemopreventive effects primarily through the inhibition of cyclooxygenase-2 (COX-2), which diminishes the synthesis of pro-inflammatory prostaglandins and reduces chronic liver inflammation, a key driver of hepatocarcinogenesis. […] Statins lower cholesterol levels and exhibit anti-inflammatory and immunomodulatory effects that may help inhibit carcinogenesis. […] Metformin, a widely used antidiabetic medication, has shown potential in reducing HCC incidence through multiple mechanisms. […] GLP-1 agonists have emerged as potential chemopreventive agents for HCC, particularly in patients with type 2 diabetes. […] SGLT2 inhibitors, primarily used for managing type 2 diabetes, improve glycemic control and reduce insulin resistance, both of which are implicated in the development of HCC.

• #1

  https://www.xiahepublishing.com/2310-8819/JCTH-2021-00257

  Aspirin use may reduce the risk of hepatocellular carcinoma (HCC). […] The study aim was to investigate the efficacy and safety of aspirin for prevention of HCC. […] Aspirin use was associated with a reduced risk of HCC (HR=0.64, 95% CI: 0.560.75). […] The preventive effect was well reproduced in those with comorbidities. […] Daily use and long-term use of aspirin appeared to offer greater benefits. […] Aspirin 100 mg/d was associated with maximum reduction of HCC risk. […] Our meta-analysis confirmed that use of aspirin significantly reduced the incident risk of HCC. […] Regular and long-term aspirin use offers a greater advantage. […] We recommend 100 mg/d aspirin as a feasible dose for further research on primary prevention of HCC in a broad at-risk population. […] The preventive effect of aspirin on HCC was robust regardless of the geographical region area (i.e., Western or Asian countries).

• #1

  https://xiahepublishing.com/2310-8819/JCTH-2021-00257

  Our study indicated that aspirin may be useful in reducing the risk of HCC in at-risk populations. […] With respect to the optimal duration and frequency of aspirin use for HCC prevention, use of aspirin for more than 3 years and daily use of aspirin were more effective in preventing HCC than short duration and irregular use. […] Furthermore, on dose-response analysis, aspirin 100 mg per day was associated with the greatest benefits for HCC prevention. […] Aspirin use in patients with the four comorbidities was found to notably reduce the risk of HCC. […] The risk of aspirin-related serious bleeding is a major impediment to the wider use of aspirin for preventing HCC in high-risk populations. […] Aspirin use did increase the risk of bleeding by 14%.

• #1 Hepatocellular carcinoma chemoprevention in chronic hepatitis B patients: all-in on statins? – Ursic-Bedoya – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/37646/html

  The rationale behind statins use to prevent cancer lies in the biological pathways implicated in the response to statins. […] Numerous (and heterogeneous) observational studies on statins have suggested a decrease in HCC incidence in different settings of chronic liver disease. A meta-analysis published in 2013 estimated a 41% decrease in HCC incidence in patients treated with statins, although between 57 (high-risk HBV positive population) and 5,209 (lower-risk population) patients needed to be treated in order to prevent one case of HCC. […] One of the main findings of the study lies in the low adjusted HR of 0.36 (95% CI: 0.190.68) associated with statin use, almost as low as that achieved with antiviral treatment (0.27, 95% CI: 0.230.32). The association with statin use and lower risk of HCC development applies especially for lipophilic statins [HR (95% CI), 0.35 (0.160.78)] such as atorvastatin, simvastatin, pitavastatin and fluvastatin, whereas marginal statistical significance was observed for hydrophilic statins. […] A final response should come from the numerous currently ongoing or recently terminated prospective trials.

• #1 Prevention of Hepatocellular Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5040884/

  Early diagnosis of ALD is important to encourage alcohol abstinence, minimize the progression of liver fibrosis, and manage cirrhosis-related complications including HCC. […] Weight reduction, e.g. by bariatric surgery, has been demonstrated to improve liver fibrosis. […] Targeting the obesity-related inflammation and improvement of insulin resistance with the aim of chemoprevention of hepatocarcinogenesis is in the focus of current research. […] In diabetics, the use of metformin is associated with a reduced incidence of HCC. […] The pathogenesis of HCC in NAFLD is multifactorial involving obesity-mediated mechanisms leading to low-grade chronic inflammation. […] Preventive measures include public health strategies aiming at a reduction of aflatoxin exposure, including agricultural strategies, methods to reduce humidity and fungal growth, and pharmacological interventions to attenuate the toxicological consequences of unavoidable aflatoxin exposure. […] It will be one of the major challenges to improve awareness for patients at risk for HCC development even in the absence of cirrhosis and develop efficient and effective monitoring and intervention strategies to prevent HCC.

• #1 Prevention of hepatocellular carcinoma: a concise review of contemporary issues | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-prevention-hepatocellular-carcinoma-concise-review-S1665268119309226

  Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer deaths in men. […] Strategies to limit the impact of HCC include primary prevention against new cases of viral hepatitis, secondary prevention of HCC in susceptible individuals, and early HCC detection. Universal hepatitis B vaccination has resulted in dramatic reduction in incident cases of chronic hepatitis B and HCC in children and adolescents, and the full effect is expected in the next 20 years. […] HCC surveillance by regular ultrasound examination and alpha fetoprotein testing leads to early cancer detection and offers the opportunity for curative treatment. […] The aim of HCC surveillance programs is to identify early cancers so that the patients may still undergo curative treatment and achieve complete remission.

• #1 Hepatocellular Carcinoma Prevention in the Era of Hepatitis C Elimination

  https://www.mdpi.com/1422-0067/24/18/14404

  EASL recommends semi-annual abdominal ultrasound exams, without determination of serum AFP level, not only for HCV patients with cirrhosis but also for those with the METAVIR F3 stage of fibrosis. […] Secondary prevention based on semi-annual surveillance is associated with improvements in early tumor detection and reduced HCC mortality. […] EASL recommends semi-annual abdominal ultrasound exams, without determination of serum AFP level, not only for HCV patients with cirrhosis but also for those with the METAVIR F3 stage of fibrosis. […] AASLD recommends against surveillance of patients with advanced fibrosis but without cirrhosis. […] The more widely adopted strategy has been the use of the FIB-4 score, a simplified scoring system that assesses liver disease severity by combining the routine chemistries transaminases and platelet count with patient age. […] The lack of performant biomarkers for risk-stratified screening of individuals at risk of developing HCC is becoming a major barrier to the optimization of secondary prevention of this lethal disease.

• #1

  https://journals.lww.com/hep/fulltext/2023/12000/aasld_practice_guidance_on_prevention,_diagnosis,.27.aspx

  This guidance document provides an updated approach to the prevention, diagnosis, and treatment of hepatocellular carcinoma (HCC). […] Notable examples of these updates include recommendations for use of ultrasound and alpha fetoprotein (AFP) for HCC surveillance, expanded indications for surgical therapies, incorporation of immune checkpoint inhibitor (ICI) therapy for first-line systemic therapy, and explicit recommendations for multidisciplinary care and advance care planning (ACP). […] The strongest risk factor for developing HCC is cirrhosis from any liver disease etiology, which is present in over 80% of patients with HCC. […] Antiviral treatment significantly decreases HCC risk in patients with and without cirrhosis from HBV or HCV infection and remains one of the most effective methods of primary prevention for HCC.

• #1 Prevention of hepatocellular carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2023918/

  Dietary iron overload has virtually disappeared from urban Black African populations as a result of a change in their drinking habits from home-brewed sorghum-based beverages with a high iron content to commercially available iron-free varieties of alcohol. […] Secondary chemoprevention entails the use of natural or synthetic chemicals to block, retard, or reverse the carcinogenic process. […] A decrease in the risk of HCC correlates with an increased consumption of leafy green vegetables. […] Whether or not excess hepatic iron is proved to be directly hepatocarcinogenic, de-ironing of patients with hereditary hemochromatosis by repeated venesection would be expected to have a secondary preventive effect against HCC formation both by reversing the accumulation of iron and preventing the development of cirrhosis.

• #1 Hepatocellular carcinoma: Therapy and prevention

  https://www.wjgnet.com/1007-9327/full/v11/i47/7391.htm

  After successful HCC resection or non-surgical ablation, HCC recurrence in the remaining cirrhotic liver is the major limitation of life expectancy of these patients. The probability of recurrence is about 50% within 3 years after successful treatment. Strategies to prevent HCC recurrence are therefore central to the improvement of survival of HCC patients after initial cure. Apart from liver transplantation after successful resection, the strategies explored to date include administration of polyprenoic acid (an acyclic retinoid), interferon alpha and interferon beta. Furthermore, adoptive immunotherapy and intra-arterial injection of 131iodine-labeled lipiodol have been evaluated in clinical studies. All these interventions can result in lower HCC recurrence rates. These findings have to be confirmed in larger randomized controlled studies, demonstrating that a clear clinical benefit before secondary prevention with one of the strategies mentioned above should enter clinical practice.

• #1

  https://journals.lww.com/hep/fulltext/9900/critical_update__aasld_practice_guidance_on.1176.aspx

  There is a need for effective (neo)adjuvant therapy to reduce risk of HCC recurrence after surgical resection. […] AASLD advises against the use of adjuvant and neoadjuvant systemic therapies in patients undergoing liver resection/local ablation (Level 1, Strong Recommendation). […] There are currently no FDA-approved (neo)adjuvant therapies for HCC. Surveillance for recurrence is the current standard of care after resection/local ablation with the intention of cure, even in patients with a high risk of recurrence. (Neo)adjuvant therapies should be considered only in the context of a clinical trial.

• #1 A global view of hepatocellular carcinoma: trends, risk, prevention and management | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-019-0186-y

  Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related death worldwide. […] All these risk factors are potentially preventable, highlighting the considerable potential of risk prevention for decreasing the global burden of HCC. […] Prevention and treatment of viral hepatitis and mitigation of exposure to aflatoxin and aristolochic acid, the main risk factors in high-incidence regions, are critical for decreasing the global burden of HCC. […] HCC surveillance enables early detection and increases the chance of potentially curative treatment; therefore, broad implementation of HCC surveillance in high-risk patients is essential to reduce the high mortality from HCC. […] Global reduction of HCC burden can be achieved by universal HBV vaccination, control of chronic viral hepatitis, avoiding environmental and lifestyle risk factors, and improving early detection and management.

• #1 Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma

  https://www.mdpi.com/2077-0383/13/22/6770

  Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, primarily developing in the context of chronic liver disease. Traditional prevention has focused on liver-specific interventions like antiviral therapies and surveillance. However, extrahepatic factors also significantly contribute to HCC risk. This review explores comprehensive strategies for HCC prevention, including both hepatic and extrahepatic factors. […] Hepatitis B vaccination and antiviral treatments for hepatitis B and C significantly reduce HCC incidence. Lifestyle modifications—such as reducing alcohol consumption, maintaining a healthy weight through diet and exercise, and smoking cessation—are crucial in lowering HCC risk. Environmental measures to limit exposure to aflatoxins and other hazards also contribute to prevention. Regular surveillance of high-risk groups enables early detection and improves survival rates. Emerging strategies like immunotherapy and gene therapy show potential for further reducing HCC risk.

• #1 Addressing the worldwide hepatocellular carcinoma: epidemiology, prevention and management – Samant – Journal of Gastrointestinal Oncology

  https://jgo.amegroups.org/article/view/36868/html

  As we learn more about these environmental and occupational hazards, there will be additional opportunities to intervene and prevent HCC worldwide. […] Surveillance of HCC is critical since the clinical outcome depends on the ability to identify this cancer in early stages. […] Multidisciplinary team approach is critical for HCC management as newer advances continue to change landscape of this disease.

• #2 Prevention of hepatocellular carcinoma: a concise review of contemporary issues | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-prevention-hepatocellular-carcinoma-concise-review-S1665268119309226

  Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer deaths in men. […] Strategies to limit the impact of HCC include primary prevention against new cases of viral hepatitis, secondary prevention of HCC in susceptible individuals, and early HCC detection. Universal hepatitis B vaccination has resulted in dramatic reduction in incident cases of chronic hepatitis B and HCC in children and adolescents, and the full effect is expected in the next 20 years. […] HCC surveillance by regular ultrasound examination and alpha fetoprotein testing leads to early cancer detection and offers the opportunity for curative treatment. […] The aim of HCC surveillance programs is to identify early cancers so that the patients may still undergo curative treatment and achieve complete remission.

• #2 Current and emerging strategies for the prevention of hepatocellular carcinoma | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/s41575-024-01021-z

  Liver cancer is the third leading cause of cancer-related deaths globally, with incident cases expected to rise from 905,700 in 2020 to 1.4 million by 2040. Hepatocellular carcinoma (HCC) accounts for about 80% of all primary liver cancers. […] The increasing numbers of cases of HCC and changes in risk factors highlight the urgent need for updated and targeted prevention strategies. Preventive interventions encompass strategies to decrease the burden of chronic liver diseases and their progression to HCC. […] These strategies include nutritional interventions and medications that have shown promise in preclinical models. […] Although prevailing approaches focus on treating chronic liver disease, leveraging a wider range of interventions represents a promising area to safeguard at-risk populations.

• #2 Can Liver Cancer Be Prevented? | American Cancer Society

  https://www.cancer.org/cancer/types/liver-cancer/causes-risks-prevention/prevention.html

  Many liver cancers could be prevented by reducing exposure to known risk factors for this disease. […] Preventing hepatitis B (HBV) and C (HCV) infections […] The US Centers for Disease Control and Prevention (CDC) recommend that all children and adults up to age 59, as well as older adults at risk for HBV, get the HBV vaccine to reduce their risk of chronic hepatitis B and liver cancer. […] If a person has a chronic HBV or HCV infection, treatment can help slow liver damage and reduce their risk of developing liver cancer. […] Drinking alcohol can lead to cirrhosis, which in turn, can lead to liver cancer. Not drinking alcohol or drinking in moderation could help lower your risk of liver cancer. […] Staying at a healthy weight might be another way to lower your risk of liver cancer. […] Certain inherited diseases can cause cirrhosis of the liver, increasing a persons risk for liver cancer. Finding and treating these diseases early in life could lower this risk.

• #2 Latest advances in hepatocellular carcinoma management and prevention through advanced technologies | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-023-00306-3

  Hepatocellular carcinoma (HCC) is a common type of liver cancer, with a high mortality rate. […] Lifestyle modifications, such as weight management, alcohol avoidance, and hepatitis B vaccinations, can play a critical role in preventing HCC development. […] Primary prevention of HCC can be achieved through vaccination against hepatitis B virus (HBV) and early treatment of chronic HBV or hepatitis C virus (HCV) infection. […] Vaccination against hepatitis B virus (HBV) is one of the most effective prevention strategies for HCC. A large-scale study showed that universal HBV vaccination programs have greatly reduced the incidence of HCC in Taiwan, with the incidence decreasing by 70% in the vaccinated population compared to the unvaccinated population. […] Lifestyle modifications, such as maintaining a healthy weight, avoiding alcohol and tobacco use, and increasing physical activity, have also been shown to reduce the risk of HCC.

• #2 Liver (Hepatocellular) Cancer Prevention (PDQ®) – NCI

  https://www.cancer.gov/types/liver/hp/liver-prevention-pdq

  Interventions With Adequate Evidence of Decreased Risk of HCC: […] HBV vaccination […] Based on solid evidence, neonatal HBV vaccination or catch-up vaccination at young ages reduces HCC incidence in young adults. […] Treatment for chronic HBV infection […] Based on solid evidence, chronic HBV treatment with nucleos(t)ide analogue therapy reduces the risk of HCC. […] Availability of food not contaminated with aflatoxin B1 […] Based on solid evidence, replacement of food highly contaminated with aflatoxin B1 with food that harbors much lower levels of aflatoxin B1 leads to a reduction in liver cancer mortality. […] Interventions With Inadequate Evidence of Decreased Risk of HCC: […] HCV treatment with direct-acting antivirals (DAAs) […] Based on fair evidence, HCV treatment with DAAs that results in sustained virological response (SVR) may reduce HCC risk. […] Statin use among adults with HBV or HCV […] Based on fair evidence, statin use may be associated with a reduced risk of developing HCC in patients with HBV or HCV infection.

• #2 Liver (Hepatocellular) Cancer Prevention: Prevention – Patient Information [NCI] – Women’s Health – Associates for Women’s Medicine – Syracuse NY Gynecologist, Gynecology, Obstetrics, OBGYN, OB Physicians, Syracuse New York, Fayetteville, North Syracuse,

  https://www.afwomensmed.com/health-library/hw-view.php?DOCHWID=ncicdr0000433423

  The following are protective factors for liver cancer: Getting the hepatitis B vaccine: Preventing HBV infection (by being vaccinated for HBV as a newborn) has been shown to lower the risk of liver cancer in children. […] Getting treatment for chronic hepatitis B infection: Treatment options for people with chronic HBV infection include interferon and nucleos(t)ide analog therapy. These treatments may reduce the risk of developing liver cancer. […] Reducing exposure to aflatoxin B1: Replacing foods that contain high amounts of aflatoxin B1 with foods that contain a much lower level of the poison can reduce the risk of liver cancer.

• #2 Hepatocellular Carcinoma Prevention in the Era of Hepatitis C Elimination

  https://www.mdpi.com/1422-0067/24/18/14404

  Hepatocellular carcinoma (HCC) has an increased mortality rate globally, which is more accentuated in Western countries. […] HCC-related mortality should be prioritized through early detection, continued prevention of HCV transmission, and treatment of HCV with safe and efficacious direct antiviral agents (DAAs). […] Given the restless accumulation of individuals with cured HCV infection, the implementation of risk-stratified surveillance programs becomes impellent from a cost-effectiveness perspective, whereas the availability of a performant biomarker to predict HCC in cured patients remains an unmet clinical need. […] Patients with cirrhosis and METAVIR F3 liver fibrosis due to chronic HCV infection are at risk of developing HCC at a rate greater than the 1.5% per year threshold. […] Given that HCV eradication by antiviral treatment reduces but does not eliminate HCC risk, these same recommendations hold true for patients with a similar stage of disease who have been treated and cured for chronic HCV infection.

• #2 Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma

  https://www.mdpi.com/2077-0383/13/22/6770

  Obesity and metabolic syndrome are associated with MASLD, which can progress to metabolic dysfunction-associated steatohepatitis (MASH) and subsequently increase the risk of HCC. Engaging in regular physical activity and maintaining a healthy body weight have been shown to reduce hepatic fat accumulation, improve insulin sensitivity, and decrease liver inflammation, thereby lowering the risk of HCC development. […] Aflatoxin B1, produced by Aspergillus species and primarily transmitted through contaminated food, is a significant risk factor for HCC in developing countries. Strategies to reduce aflatoxin exposure—such as improving agricultural practices, ensuring proper food storage, and utilizing processing methods to prevent fungal contamination—have been effective in decreasing HCC incidence.

• #2 Prevention of Hepatocellular Carcinoma

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5040884/

  Early diagnosis of ALD is important to encourage alcohol abstinence, minimize the progression of liver fibrosis, and manage cirrhosis-related complications including HCC. […] Weight reduction, e.g. by bariatric surgery, has been demonstrated to improve liver fibrosis. […] Targeting the obesity-related inflammation and improvement of insulin resistance with the aim of chemoprevention of hepatocarcinogenesis is in the focus of current research. […] In diabetics, the use of metformin is associated with a reduced incidence of HCC. […] The pathogenesis of HCC in NAFLD is multifactorial involving obesity-mediated mechanisms leading to low-grade chronic inflammation. […] Preventive measures include public health strategies aiming at a reduction of aflatoxin exposure, including agricultural strategies, methods to reduce humidity and fungal growth, and pharmacological interventions to attenuate the toxicological consequences of unavoidable aflatoxin exposure. […] It will be one of the major challenges to improve awareness for patients at risk for HCC development even in the absence of cirrhosis and develop efficient and effective monitoring and intervention strategies to prevent HCC.

• #2

  https://winshipcancer.emory.edu/cancer-types-and-treatments/liver-cancer/prevention.php

  There is no known cure for liver cancer, but there are steps you can take to lower your risk. […] The good news is there are ways to prevent liver cancer by making lifestyle changes that can help reduce your risk. […] Certain hereditary traits, as well as age, sex and race, cannot be altered with lifestyle changes. But there are measures you can take to help protect yourself against environmental factors that can lead to liver cancer. […] The National Cancer Institute advises that you: Maintain a healthy weight. Avoid smoking. Limit your alcohol intake. Vaccinate against hepatitis B. The vaccine is recommended for all infants and for adults who may be at an elevated risk of liver cancer. Protecting against hepatitis can reduce overall incidences of liver cancer by half. Test for hepatitis C and receive medical care if you test positive. Additional steps include using a condom during sexual intercourse and avoiding the use of intravenous drugs. Screen for liver cancer if you have multiple risk factors for the disease.

• #2 Liver cancer – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-cancer/symptoms-causes/syc-20353659

  Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you: Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day. Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly 1 or 2 pounds (0.5 to 1 kilograms) each week. […] You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

• #2 Coffee, including caffeinated and decaffeinated coffee, and the risk of hepatocellular carcinoma: a systematic review and dose–response meta-analysis | BMJ Open

  https://bmjopen.bmj.com/content/7/5/e013739

  Increased consumption of caffeinated coffee and, to a lesser extent, decaffeinated coffee are associated with reduced risk of HCC, including in pre-existing liver disease. […] An extra two cups per day of coffee was associated with a 35% reduction in the risk of HCC (RR 0.65, 95%CI 0.59 to 0.72). […] An extra two cups of caffeinated and decaffeinated coffee (2 and 3 cohort studies, respectively) were associated with reductions of 27% (RR 0.73, 95%CI 0.63 to 0.85) and 14% (RR 0.86, 95%CI 0.74 to 1.00) in the risk of HCC. […] The association was also not significantly different for the main exposures for HCC: high alcohol consumption, smoking, high BMI, T2DM and HBV/HCV. […] Our findings suggest a central role for caffeine, given that the association was weaker for decaffeinated coffee. […] This is the strongest evidence to date of an association between decaffeinated coffee and HCC. […] Randomised trials should investigate the effectiveness of increasing coffee consumption in those at risk of HCC including patients with existing CLD.

• #2 AASLD Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma Guideline Summary

  https://www.guidelinecentral.com/guideline/10743/

  Patients with chronic liver disease should be counseled to maintain a healthy weight, have a balanced diet, avoid tobacco and alcohol, and achieve adequate control of comorbid conditions including components of the metabolic syndrome. A healthy lifestyle has multiple benefits and may decrease HCC risk (Level 3, Strong Recommendation). […] Coffee consumption may be recommended for patients with chronic liver disease, as it has associated with decreased risk of HCC development (Level 5, Weak Recommendation, 12 of 15 agree). […] AASLD does not advise use of other chemoprevention therapies such as statins, aspirin, and metformin solely to reduce HCC risk, despite some evidence of risk reduction (Level 5, Weak Recommendation).

• #2

  https://www.xiahepublishing.com/2310-8819/JCTH-2021-00257

  Aspirin use may reduce the risk of hepatocellular carcinoma (HCC). […] The study aim was to investigate the efficacy and safety of aspirin for prevention of HCC. […] Aspirin use was associated with a reduced risk of HCC (HR=0.64, 95% CI: 0.560.75). […] The preventive effect was well reproduced in those with comorbidities. […] Daily use and long-term use of aspirin appeared to offer greater benefits. […] Aspirin 100 mg/d was associated with maximum reduction of HCC risk. […] Our meta-analysis confirmed that use of aspirin significantly reduced the incident risk of HCC. […] Regular and long-term aspirin use offers a greater advantage. […] We recommend 100 mg/d aspirin as a feasible dose for further research on primary prevention of HCC in a broad at-risk population. […] The preventive effect of aspirin on HCC was robust regardless of the geographical region area (i.e., Western or Asian countries).

• #2

  https://xiahepublishing.com/2310-8819/JCTH-2021-00257

  Aspirin use may reduce the risk of hepatocellular carcinoma (HCC). […] The study aim was to investigate the efficacy and safety of aspirin for prevention of HCC. […] Aspirin use was associated with a reduced risk of HCC (HR=0.64, 95% CI: 0.560.75). […] The preventive effect was well reproduced in those with comorbidities. […] Daily use and long-term use of aspirin appeared to offer greater benefits. […] Aspirin 100 mg/d was associated with maximum reduction of HCC risk. […] Our meta-analysis confirmed that use of aspirin significantly reduced the incident risk of HCC. […] Regular and long-term aspirin use offers a greater advantage. […] We recommend 100 mg/d aspirin as a feasible dose for further research on primary prevention of HCC in a broad at-risk population. […] The preventive effect of aspirin on HCC was robust regardless of the geographical region area (i.e., Western or Asian countries).

• #2 Hepatocellular carcinoma chemoprevention in chronic hepatitis B patients: all-in on statins? – Ursic-Bedoya – Hepatobiliary Surgery and Nutrition

  https://hbsn.amegroups.org/article/view/37646/html

  The rationale behind statins use to prevent cancer lies in the biological pathways implicated in the response to statins. […] Numerous (and heterogeneous) observational studies on statins have suggested a decrease in HCC incidence in different settings of chronic liver disease. A meta-analysis published in 2013 estimated a 41% decrease in HCC incidence in patients treated with statins, although between 57 (high-risk HBV positive population) and 5,209 (lower-risk population) patients needed to be treated in order to prevent one case of HCC. […] One of the main findings of the study lies in the low adjusted HR of 0.36 (95% CI: 0.190.68) associated with statin use, almost as low as that achieved with antiviral treatment (0.27, 95% CI: 0.230.32). The association with statin use and lower risk of HCC development applies especially for lipophilic statins [HR (95% CI), 0.35 (0.160.78)] such as atorvastatin, simvastatin, pitavastatin and fluvastatin, whereas marginal statistical significance was observed for hydrophilic statins. […] A final response should come from the numerous currently ongoing or recently terminated prospective trials.

• #2 Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma

  https://www.mdpi.com/2077-0383/13/22/6770

  Aspirin demonstrates its chemopreventive effects primarily through the inhibition of cyclooxygenase-2 (COX-2), which diminishes the synthesis of pro-inflammatory prostaglandins and reduces chronic liver inflammation, a key driver of hepatocarcinogenesis. […] Statins lower cholesterol levels and exhibit anti-inflammatory and immunomodulatory effects that may help inhibit carcinogenesis. […] Metformin, a widely used antidiabetic medication, has shown potential in reducing HCC incidence through multiple mechanisms. […] GLP-1 agonists have emerged as potential chemopreventive agents for HCC, particularly in patients with type 2 diabetes. […] SGLT2 inhibitors, primarily used for managing type 2 diabetes, improve glycemic control and reduce insulin resistance, both of which are implicated in the development of HCC.

• #2 Hepatocellular Carcinoma Prevention in the Era of Hepatitis C Elimination

  https://www.mdpi.com/1422-0067/24/18/14404

  EASL recommends semi-annual abdominal ultrasound exams, without determination of serum AFP level, not only for HCV patients with cirrhosis but also for those with the METAVIR F3 stage of fibrosis. […] Secondary prevention based on semi-annual surveillance is associated with improvements in early tumor detection and reduced HCC mortality. […] EASL recommends semi-annual abdominal ultrasound exams, without determination of serum AFP level, not only for HCV patients with cirrhosis but also for those with the METAVIR F3 stage of fibrosis. […] AASLD recommends against surveillance of patients with advanced fibrosis but without cirrhosis. […] The more widely adopted strategy has been the use of the FIB-4 score, a simplified scoring system that assesses liver disease severity by combining the routine chemistries transaminases and platelet count with patient age. […] The lack of performant biomarkers for risk-stratified screening of individuals at risk of developing HCC is becoming a major barrier to the optimization of secondary prevention of this lethal disease.

• #2 Prevention of hepatocellular carcinoma: a concise review of contemporary issues | Annals of Hepatology

  https://www.elsevier.es/es-revista-annals-hepatology-16-articulo-prevention-hepatocellular-carcinoma-concise-review-S1665268119309226

  Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer deaths in men. […] Strategies to limit the impact of HCC include primary prevention against new cases of viral hepatitis, secondary prevention of HCC in susceptible individuals, and early HCC detection. Universal hepatitis B vaccination has resulted in dramatic reduction in incident cases of chronic hepatitis B and HCC in children and adolescents, and the full effect is expected in the next 20 years. […] HCC surveillance by regular ultrasound examination and alpha fetoprotein testing leads to early cancer detection and offers the opportunity for curative treatment. […] The aim of HCC surveillance programs is to identify early cancers so that the patients may still undergo curative treatment and achieve complete remission.

• #2 Liver (Hepatocellular) Cancer Prevention (PDQ®): Prevention – Health Professional Information [NCI] | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.liver-hepatocellular-cancer-prevention-pdq%C2%AE-prevention-health-professional-information-nci.ncicdr0000433282

  Chronic hepatitis B virus (HBV) infection is the leading cause of hepatocellular cancer (HCC) in Asia and Africa. […] Chronic hepatitis C virus (HCV) infection is the leading cause of HCC in North America, Europe, and Japan. […] Based on solid evidence, cirrhosis, regardless of its etiology, predisposes patients to HCC. […] Based on solid evidence, heavy alcohol use increases HCC risk. […] Based on solid evidence, aflatoxin B1 exposure increases HCC risk. […] Based on fair evidence, NASH increases risk of HCC. […] Based on fair evidence, cigarette smoking increases HCC risk. […] Based on solid evidence, untreated hereditary hemochromatosis, alpha-1-antitrypsin deficiency, glycogen storage disease, porphyria cutanea tarda, and Wilson disease increase the risk of HCC, but account for few cases.

• #2 Hepatocellular carcinoma: Therapy and prevention

  https://www.wjgnet.com/1007-9327/full/v11/i47/7391.htm

  Stage 4: Interventions at this step are aimed at interfering with the molecular events leading to HCC development, usually in a cirrhotic liver. These strategies include all treatment modalities detailed above (stage 3) as far as they can be implemented in patients with compensated or decompensated liver cirrhosis. In addition, some of the measures to prevent HCC recurrence after successful HCC treatment (secondary prevention) should in principle be useful for HCC prevention at this stage of the disease. Furthermore, some concepts of molecular therapy of HCCs should be applicable also in the prevention of HCCs. Without experimental pre-clinical data on these issues, it would be premature to discuss their potential clinical impact. […] Secondary HCC prevention The prevention of a local recurrence and/or the development of new HCC lesions in patients after successful surgical or non-surgical HCC treatment is of paramount importance and can significantly improve disease-free and overall patient survival.

• #2 AASLD Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma Guideline Summary

  https://www.guidelinecentral.com/guideline/10743/

  AASLD advises against the use of adjuvant and neoadjuvant systemic therapies in patents undergoing liver resection/local ablation. […] Public health policies and interventions should be implemented to address the significant mortality of HCC in the United States (Level 5, Strong Recommendation). […] Vaccination for HBV infection should be given in all newborns as well as high-risk adults who failed to receive vaccination at birth to reduce the risk of HCC (Level 2, Strong Recommendation). […] Antivirals should be given in all patients who meet criteria for treatment according to AASLD Guidance documents for HBV and HCV infection. In patients with chronic viral hepatitis, suppression of HBV and eradication of HCV infection decreases the risk of HCC development (Level 2, Strong Recommendation).

• #2 Beyond the Liver: A Comprehensive Review of Strategies to Prevent Hepatocellular Carcinoma

  https://www.mdpi.com/2077-0383/13/22/6770

  Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide, primarily developing in the context of chronic liver disease. Traditional prevention has focused on liver-specific interventions like antiviral therapies and surveillance. However, extrahepatic factors also significantly contribute to HCC risk. This review explores comprehensive strategies for HCC prevention, including both hepatic and extrahepatic factors. […] Hepatitis B vaccination and antiviral treatments for hepatitis B and C significantly reduce HCC incidence. Lifestyle modifications—such as reducing alcohol consumption, maintaining a healthy weight through diet and exercise, and smoking cessation—are crucial in lowering HCC risk. Environmental measures to limit exposure to aflatoxins and other hazards also contribute to prevention. Regular surveillance of high-risk groups enables early detection and improves survival rates. Emerging strategies like immunotherapy and gene therapy show potential for further reducing HCC risk.

• #2 Effect of health education intervention on hepatocellular carcinoma risk factor prevention in Menoufia governorate, Egypt | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-019-0011-x

  The health education intervention about HCC and prevention of its risk factors was effective in decreasing percent of poor knowledge about HCC from 33.5% pre-intervention to 1.1% post-intervention and in increasing the percent of good knowledge about HCC from 66.5% pre-intervention to 98.9% post-intervention, and this effect was of high statistical significance. […] The health education intervention about HCC and its risk factors prevention was effective in decreasing percent of poor knowledge about HBV and HCV from 11.2% pre-intervention to 0% post-intervention and in increasing percent of good knowledge about HBV and HCV from 88.8% pre-intervention to 100% post-intervention, and this effect was statistically highly significant. […] In conclusion, we found that health education intervention about HCC and prevention of its risk factors was feasible and is an effective way for raising awareness and improvement of practices of rural community in Menoufia governorate, Egypt.

• #2 Cancer prevention and control: hepatocellular carcinoma – ecancer

  https://ecancer.org/en/journal/article/949-cancer-prevention-and-control-hepatocellular-carcinoma

  Altogether, these developments set the scene for a radical paradigm shift in the management of liver cancer in Africa, bringing within the realm of possibility a reduction of mortality of 50% or more over the next generation. This will require careful planning for combining risk reduction, primary prevention, screening and early detection, local ablation and biomarker-based targeted systemic therapies.

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