title: Non‑infective occupational risk factors for hepatocellular carcinoma: A review (Review).
abstract: Liver cancer is the second leading worldwide cause of cancer‑associated mortalities. Hepatocellular carcinoma, which accounts for the majority of liver tumors, ranks fifth among types of human cancer. Well‑established risk factors for liver cancer include the hepatitis B and C viruses, aflatoxins, alcohol consumption, and oral contraceptives. Tobacco smoking, androgenic steroids, and diabetes mellitus are suspected risk factors. Current knowledge regarding non‑infective occupational risk factors for liver cancer is inconclusive. The relevance of liver disorders to occupational medicine lies in the fact that the majority of chemicals are metabolized in the liver, and toxic metabolites generated via metabolism are the predominant cause of liver damage. However, their non‑specific clinical manifestations that are similar in a number of liver diseases make diagnosis difficult. Furthermore, concomitant conditions, such as viral hepatitis and alcohol or drug abuse, may mask liver disorders that result from occupational hepatotoxic agents and block the demonstration of an occupational cause. The identification of environmental agents that result in human cancer is a long and often difficult process. The purpose of the present review is to summarize current knowledge regarding the association of non‑infective occupational risk exposure and HCC, to encourage further research and draw attention to this global occupational public health problem.
authors.affiliation: Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Ledda
authors.affiliation: Human Anatomy and Histology, Department of Biomedical and Biotechnology Sciences, University of Catania, I-95123 Catania, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Loreto
authors.affiliation: Anatomy Department, Faculty of Medicine and Surgery, University of Malta, MSD‑2080 Msida, Malta.
authors.forename: Christian
authors.initials: C
authors.lastname: Zammit
authors.affiliation: Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marconi
authors.affiliation: Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Fago
authors.affiliation: Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Matera
authors.affiliation: Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Costanzo
authors.affiliation: Division of Radiology, 'Policlinico‑Vittorio Emanuele' University Hospital, University of Catania, I‑95123 Catania, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fuccio Sanzà
authors.affiliation: Division of Radiology, 'Policlinico‑Vittorio Emanuele' University Hospital, University of Catania, I‑95123 Catania, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Palmucci
authors.affiliation: Hygiene and Public Health, Department of Medical Sciences, Surgical and Advanced Technologies 'GF Ingrassia', University of Catania, I-95123 Catania, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Ferrante
authors.affiliation: Occupational Medicine, Department of the Environment, Safety, Territory, Food and Health Sciences, University of Messina, I‑98125 Messina, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Costa
authors.affiliation: Occupational Medicine, Department of the Environment, Safety, Territory, Food and Health Sciences, University of Messina, I‑98125 Messina, Italy.
authors.forename: Concettina
authors.initials: C
authors.lastname: Fenga
authors.affiliation: General Surgery, Department of General Surgery and Medical‑Surgical Specialties, University of Catania, I‑95123 Catania, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Biondi
authors.affiliation: Anatomy Department, Faculty of Medicine and Surgery, University of Malta, MSD‑2080 Msida, Malta.
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Pomara
authors.affiliation: Occupational Medicine, Department of Clinical and Experimental Medicine, University of Catania, I-95123 Catania, Italy.
authors.forename: Venerando
authors.initials: V
authors.lastname: Rapisarda
mesh_terms: D001151:Arsenic / Q000633:toxicity; D002104:Cadmium / Q000633:toxicity; D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D004147:Dioxins / Q000633:toxicity; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology*; D009602:Nitrosamines / Q000633:toxicity; D016273:Occupational Exposure; D010575:Pesticides / Q000633:toxicity; D011078:Polychlorinated Biphenyls / Q000633:toxicity; D012307:Risk Factors
chemical_list: D004147:Dioxins; D009602:Nitrosamines; D010575:Pesticides; D002104:Cadmium; D011078:Polychlorinated Biphenyls; D001151:Arsenic