A major health concern for those living with hepatitis C virus (HCV) is the threat of hepatocellular carcinoma (HCC, the most common form of liver cancer). Hep C increases the overall risk of developing the potentially fatal cancer by a whopping 17-fold.

Research suggests that it’s not so much hep C itself that causes liver cancer, but rather the direct toll the virus takes on the organ. For the most part, liver cancer develops in people with hep C if they already have severe scarring of the liver—advanced fibrosis or cirrhosis—and if they have been living with the virus for at least 20 years. About 2 to 6 HCV-positive individuals with cirrhosis will develop liver cancer each year. However, there have been cases of liver cancer developing among those with more minimal liver damage. Because of this, some scientists feel they can’t rule out hep C’s direct influence on the development of liver cancer.

Fortunately, there is a good deal that people with hep C can do to reduce their risk of liver cancer. Note that many of the lifestyle changes recommended to lower the risk are intended to promote overall liver health, given the contribution of liver scarring to liver cancer risk. Also, much of the research about reducing the risk of liver cancer is not focused on people with hep C. So sometimes it is a bit of a stretch to presume that what lowers the risk of the cancer for someone without hep C will have a similar benefit among those living with the virus.

Get treated. In a meta-analysis of 129 studies of hep C treatments including almost 35,000 people with the virus, those who were cured of HCV had a 68 to 79 percent reduced risk of developing liver cancer within five years, when compared with those whose hep C treatment failed. Looking at the percentage of those who developed liver cancer within five years of hep C treatment, the researchers found that the respective rates of those who were cured versus not cured were: 0.9 percent and 10 percent among those coinfected with HCV and HIV; 5.3 percent and 13.9 percent among those with just HCV who had cirrhosis; and 2.9 percent and 9.3 percent among non-cirrhotic people with just hep C.

The great news is that recent improvements in hep C therapies have made curing the virus much faster and considerably more tolerable than in the days when the onerous injectable interferon was a treatment mainstay. For many people with HCV, the chance of a cure is about 95 percent or greater. Plus, new medications will continue to roll out in the near future, addressing the needs of even more people living with the virus.

Keep in mind that, post-hep C cure, the risk of liver cancer, while markedly reduced by successful HCV treatment, is still elevated when compared to people who never had the virus. Those who are cured of hep C will need to remain in routine medical care to monitor their liver health.

Treat and prevent other forms of viral hepatitis. Coinfection with hepatitis B virus (HBV) may raise the risk of liver cancer among people with hep C. Hep B also apparently increases the chances that people with hep C will develop liver cancer when they don’t have advanced liver scarring—by almost four-fold, according to one recent study. So it’s important to seek treatment for HBV. Both HBV and hepatitis A virus (HAV) are preventable with vaccines; anyone with hep C should ask a physician about vaccinations if they haven’t already had them.

Diet and exercise. Unfortunately, there isn’t good data suggesting that regular exercise lowers the risk of liver cancer among people with hep C. However, efforts to maintain a healthy weight through physical activity can reduce chance of diabetes, non-alcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), all of which can contribute to liver cancer risk.

Research has also found that consuming foods that boost blood sugar levels to excess is linked with liver cancer among those with hep B or C. For a healthier option, consider the so-called Mediterranean diet, which apparently lowers the risk of liver cancer—a benefit that is particularly pronounced among those with hep B or C. This means favoring olive oil and consuming a diet rich in nuts, fish, beans, fresh veggies and fruits, and whole grains.

Obesity. Being obese is linked with NAFLD and diabetes, both of which increase liver cancer risk. Among the general population, obesity has been associated with a 1.5- to 4.5-fold greater risk of liver cancer.

Diabetes. Hep C raises the risk of diabetes, which further raises the risk of liver cancer. According to one recent study, those who developed diabetes while living with hep C almost doubled their risk of liver cancer.

Alcohol. Physicians generally advise people with hep C to cut out alcohol entirely, because it can accelerate liver damage. Drinking is particularly risky for people with advanced liver disease. For those who cannot eliminate alcohol completely, cutting back as much as possible is still a good idea when it comes to protecting the liver.

Smoking. It’s no news that smoking is a major detriment to health. But some may not be aware that cigarettes can cause cancer in parts of the body other than those directly affected by smoke. The liver metabolizes harmful chemicals ingested from smoking, which can lead to cancer of the organ as a result.

Coffee. Research in the general population has shown that drinking coffee, even decaf, promotes liver health and lowers the risk of liver cancer. In one study, people who consumed three or more cups a day, when compared with those who didn’t partake, had lower levels of abnormal liver enzymes. Three meta-analyses of studies from Europe and Asia found that drinking coffee lowered liver cancer risk by 40 percent.