By Will Boggs, MD

NEW YORK (Reuters Health) Sept 17 - Heavy alcohol use, diabetes, and viral hepatitis combine synergistically to elevate the risk for hepatocellular carcinoma (HCC), according to a report in the September 1st issue of Cancer.

As lead investigator Dr. Jian-Min Yuan told Reuters Health, "physicians should be aware of the increased risk of HCC for their patients who are obese and possess additional risk factors such as hepatitis virus infection and heavy alcohol consumption."

Dr. Yuan from the University of Southern California, Los Angeles and colleagues examined viral and nonviral risk factors for HCC among 295 patients with HCC and 435 matched controls.

As expected, hepatitis B virus and hepatitis C virus infections were independent risk factors for HCC, the authors report, with hepatitis C virus exerting a stronger effect on HCC risk.

Moderate alcohol consumption was associated with a 40% decrease in the risk for HCC (compared to abstinence), but heavy alcohol consumption significantly increased the risk for HCC. In addition, a history of diabetes increased the risk of HCC 2.7-fold.

Heavy drinking in those with a history of diabetes elevated the risk of HCC more than 17-fold, the investigators report. Moreover, the combined effects of viral hepatitis and diabetes and of viral hepatitis and heavy alcohol consumption were more than additive. Each combination increased the risk for HCC about 48-fold.

"These factors," the authors conclude, "are likely contributors to the rising incidence of HCC in the U.S."

Screening such patients, Dr. Yuan added "will help in early detection of HCC, and HCC in the early stage is manageable and even treatable."

Cancer 2004;101:1009-1017.

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