American Board of Internal Medicine (ABIM) Certification Practice Exam

What factor increases the risk for hepatocellular carcinoma (HCC) in patients with HBV infection?

1. Age under 20

2. Family history of liver disease

3. Presence of cirrhosis

4. Elevated blood pressure

The correct answer is: Presence of cirrhosis

The presence of cirrhosis significantly increases the risk for hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) infection. Cirrhosis results from chronic liver damage, which can be caused by persistent HBV infection. As the liver undergoes repeated injury and regeneration, the risk of developing cancerous changes in liver cells escalates. HCC is more likely to arise in a cirrhotic liver due to the altered cellular environment and the increased frequency of cell division in response to ongoing damage. This increased cellular turnover, along with the accumulation of mutations, can lead to the transformation of liver cells into malignant ones. Therefore, in patients with HBV-related disease, the presence of cirrhosis is a critical factor that dramatically heightens the risk of developing HCC. In contrast, factors such as age under 20, family history of liver disease, and elevated blood pressure do not have a direct correlation with the heightened risk of HCC in the context of HBV. While these factors can indicate overall health issues or increased liver disease risk, cirrhosis is the specific condition closely linked to the development of liver cancer in individuals with chronic HBV infection.