Age May Inform Risk Stratification in Alcohol-Related HCC

Heavy alcohol consumption was associated with a significantly greater risk of hepatocellular carcinoma (HCC) among middle-aged and older adults, with the strongest association observed in those 60 years and older, according to a nationwide cohort study of more than 3.8 million adults in South Korea.¹ The findings, appearing in JHEP Reports, indicate that the relationship between alcohol intake and HCC risk is not uniform across the lifespan, and that age should be considered when assessing alcohol-related liver cancer risk in clinical practice.

“These findings may inform age-tailored HCC risk assessment and prevention strategies, particularly by identifying middle-aged and older heavy drinkers who may benefit from more careful risk stratification,” the authors concluded in the publication.

Data Source and Patient Characteristics

Investigators drew upon data from the Korean National Health Insurance Service database and included for analysis 3,869,084 adults aged 20 years and older who underwent a national health examination in 2009 and had no prior cancer diagnosis. Participants were classified as non-drinkers, light-to-moderate drinkers, or heavy drinkers based on a self-administered questionnaire, with heavy drinking defined as 30 g/day or more of alcohol for men and 20 g/day or more for women. Over a median follow-up of 11.3 years, 20,475 participants were newly diagnosed with HCC.

Non-drinkers, light-to-moderate drinkers, and heavy drinkers comprised 49.5%, 41.6%, and 8.9% of the cohort, respectively. Compared with non-drinkers, both light-to-moderate and heavy drinkers were younger, more likely to be male and current smokers, and had a higher prevalence of fatty liver; heavy drinkers had the highest rates of liver cirrhosis and diabetes.

Risk Increases Sharply With Age Among Heavy Drinkers

When stratified by 20-year age groups, heavy alcohol consumption was significantly associated with increased HCC risk in the 40-to-59 age group (adjusted hazard ratio [aHR], 1.11; 95% CI, 1.05-1.18) and the 60-and-older age group (aHR, 1.47; 95% CI, 1.38-1.57), with no significant association observed among adults aged 20 to 39 years. Light-to-moderate drinking was not significantly associated with increased HCC risk in the total population or in any age group after adjustment for confounders.

Among heavy drinkers, HCC incidence rates rose sharply with age, from 0.12 per 1000 person-years in those aged 20 to 39 years, to 0.84 per 1000 person-years in those aged 40 to 59 years, and 2.64 per 1000 person-years in those 60 years and older. The 10-year cumulative HCC risk among heavy drinkers was 0.07% in the youngest group, 0.73% in the middle-aged group, and 2.51% in the oldest group.

A dose-response pattern was also observed for drinking frequency and quantity per occasion, particularly among older adults. Consuming alcohol 5 or more days per week and 5 or more glasses per occasion were each associated with significantly higher HCC risk, with the largest effect estimates in the oldest age group.

Implications and Limitations

Alcohol consumption, particularly chronic alcohol use or abuse, is an established risk factor for liver cancer.² The study results reinforce the role of age when weighing a patient's drinking history as part of an overall liver cancer risk profile, supporting age-tailored HCC risk assessment. Heavy-drinking behavior in a 65-year-old appears to translate into a meaningfully higher absolute cancer risk than the same behavior in a 30-year-old, a distinction that could inform framing of counseling conversations or decide when additional liver-focused workup is warranted.

The authors noted several limitations of their work, including reliance on self-reported, baseline-only alcohol consumption data and the inability to fully account for lifetime drinking patterns or survivor effects among older heavy drinkers. They also cautioned that alcohol use alone should not determine HCC surveillance eligibility, which also requires consideration of cirrhosis status, competing mortality, and cost-effectiveness.

“Our findings are best interpreted as supporting age-tailored risk stratification and prevention rather than direct expansion of surveillance eligibility based solely on alcohol consumption,” they wrote.

REFERENCES

1. Kim MN, Han K, Kim DY, et al. The impact of alcohol consumption on the risk of hepatocellular carcinoma across different age groups: A nationwide cohort study. JHEP Reports. Published online August 1 2026. doi:10.1016/j.jhepr.2026.101975

2. Matsushita H, Takaki A. Alcohol and hepatocellular carcinoma. BMJ Open Gastroenterol. 2019;6(1):e000260. doi:10.1136/bmjgast-2018-000260‌