Heavy alcohol use, diabetes, and viral hepatitis combine synergistically to raise the risk of developing liver cancer, according to a new report. As lead investigator Dr. Jian-Min Yuan told, "Physicians should be aware of the increased risk of liver cancer for their patients who are obese and possess additional risk factors such as hepatitis virus infection and heavy alcohol consumption." Yuan from the University of Southern California, Los Angeles, and colleagues examined viral and non-viral risk factors for liver cancer among 295 patients with the disease and 435 matched cancer-free "controls." As expected, hepatitis B virus and hepatitis C virus infections were both risk factors for liver cancer, the authors report, with hepatitis C exerting a stronger effect. Compared with non-drinkers, moderate drinkers actually had a 40 percent lower risk of liver cancer, but heavy alcohol consumption significantly increased the risk. In addition, a history of diabetes increased the risk of liver cancer almost three-fold. Heavy drinking in those with diabetes raised the likelihood of developing liver cancer more than 17-fold, the team reports, while the combinations of viral hepatitis and diabetes or viral hepatitis and heavy alcohol consumption each increased the risk for liver cancer about 48 times. "These factors," the researchers conclude in the medical journal Cancer, "are likely contributors to the rising incidence of liver cancer in the U.S." Screening people with these risk factors, Yuan added "will help in early detection of liver cancer, and liver cancer in the early stage is manageable and even treatable."