At a significantly higher risk • Worldwide, men are twice as likely as women to develop liver cancer. • Chronic hepatitis B and/or hepatitis C virus infection, with or without cirrhosis of the liver. The usual route of transmission of hepatitis B and C is through blood transfusions or drug needles. Because hepatitis B virus may also be transmitted by a mother to her offspring during pregnancy or childbirth of may be transmitted between partners during sexual intercourse, it is not unusual for members of the same family to develop liver cancer after becoming infected with hepatitis B. • Cirrhosis of the liver from any cause—alcohol damage or inborn errors of metabolism such as hemochromatosis or enzyme deficiencies. • Exposure to aflatoxin, a fungus contaminant found in the soil in Africa. • Exposure to the fumes of vinyl chloride or to Thorotrast (a contrast material no longer used for radiologic procedures) is associated with an increased risk of angiosarcoma of the liver and hepatocellular carcinoma . At Slightly Higher Risk • Anabolic steroid use, as by weightlifters and other athletes, is known to increase the risk of benign liver tumors and may cause an increase in liver cancer. • Estrogen therapy, such as oral contraceptives, may increase the risk, although this has not been proven.