The short answer
Hepatitis C drives liver cancer through decades of inflammation. Modern antivirals cure over 95 percent of infections and cut cancer risk substantially, but not to zero.
CDC recommends that all adults aged 18 and older be tested for hepatitis C at least once, and during each pregnancy — most people with the infection have no symptoms.
An estimated 2.4 to 4 million people in the United States were living with hepatitis C in 2017 to 2020, and fewer than half of acute infections clear on their own.
Direct-acting antiviral treatment cures more than 95 percent of infections, usually in 8 to 12 weeks.
Without treatment, people with hepatitis C and cirrhosis face roughly a 1 to 4 percent chance of liver cancer each year; cure reduces that risk by roughly 71 to 79 percent.
Watch: Hepatitis C: the test everyone should get once
1 min · Captioned · Hepatitis C is silent, common, and over 95% curable — CDC says test once.
Educational only — this video explains general report language and is not medical advice. Only your care team can say what a result means for you.
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The full explanation.
A slow, silent process
Hepatitis C is a bloodborne virus that infects liver cells. Fewer than half of people who catch it clear it in the first six months. In the rest, the infection becomes chronic and lasts for decades. During that time it usually causes no symptoms at all.
What it does cause is steady low-grade inflammation. Over twenty to forty years, that inflammation drives fibrosis, which means scarring. In some people fibrosis goes on to become cirrhosis, a heavy and lasting form of scarring. Cirrhosis is the soil in which liver cancer grows — specifically hepatocellular carcinoma, cancer that starts in liver cells. Hepatitis C is a leading cause of liver cancer. It is also the leading reason for liver transplantation in the United States.
An estimated 2.4 to 4 million people in the United States were living with hepatitis C between 2017 and 2020. A large share do not know it.
Testing is the only way to find it
CDC recommends that all adults aged 18 and older be tested at least once. That holds whether or not they have any risk factor. Pregnant people should be tested during each pregnancy. Repeat testing is recommended for people with ongoing exposure. That includes people who inject drugs and share equipment, and people on maintenance haemodialysis. One-time testing is specifically recommended for people with HIV, people with abnormal liver tests, people who received blood or organ donations before July 1992, and anyone after a needlestick exposure at work.
Testing every adult exists because risk-based approaches missed too many people. Being asked about it is not an accusation.
Diagnosis takes two steps. An antibody test shows whether you have ever been exposed. If it is positive, an HCV RNA test shows whether the virus is still present. Antibodies stay in the blood after the body clears the virus on its own, and after a cure. So the RNA result is the one that answers the question. If your record holds a positive antibody test and no RNA result, that gap is worth closing.
What treatment changes
Direct-acting antiviral medicines cure more than 95 percent of hepatitis C infections. Treatment is usually 8 to 12 weeks of tablets, and generally brings few side effects. Cure is defined as sustained virologic response: no virus can be detected twelve weeks after finishing treatment.
Curing the infection greatly lowers liver cancer risk. Studies estimate a reduction of roughly 71 to 79 percent. It also slows or halts further fibrosis, and in many people some scarring regresses.
Even so, only about one in three people diagnosed in the United States has been cured. That figure comes from CDC's national hepatitis C clearance cascade analysis. Cost, insurance requirements, and access are real barriers. A case manager or patient navigator can sometimes help with them. Whether treatment is right for you, and which regimen, is a decision to make with a clinician.
Why surveillance continues after cure
This is the part most often misunderstood. Cure removes the virus. It does not remove the scarring the virus already caused.
Among people with hepatitis C and cirrhosis who are untreated, the annual risk of developing liver cancer is roughly 1 to 4 percent. After cure, that risk drops sharply, but it does not reach zero. Enough risk remains in people with cirrhosis that it still adds up over the years.
For this reason, AASLD-IDSA guidance recommends that people with cirrhosis continue liver cancer surveillance indefinitely after cure. That means abdominal ultrasound, often with a serum AFP blood test, about every six months. Nodules over a centimetre are followed up with CT or MRI.
Surveillance is not recommended routinely after cure for people with stage 3 fibrosis who do not have cirrhosis. It is not indicated at lower fibrosis stages. So bring a specific question to your clinician: do I have cirrhosis, how was that determined, and does that put me in the surveillance group?
What else you can do
Alcohol, hepatitis B co-infection, fatty liver disease, diabetes, and smoking all add to liver cancer risk, and they keep acting after cure. Vaccination against hepatitis A and B is recommended for people with chronic liver disease. And reinfection is possible — a cure gives no immunity.
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Words to know
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Common questions
I feel completely well. Why would I be tested?
Because hepatitis C is usually silent for decades. Liver damage accumulates without symptoms, and many people only learn they are infected when cirrhosis or liver cancer is already present. CDC recommends one-time testing for every adult 18 and older precisely because risk-based testing misses too many people.
My antibody test was positive. Does that mean I have hepatitis C now?
Not necessarily. A positive antibody test means you were exposed at some point. Some people clear the virus on their own, and antibodies remain afterwards. A follow-up HCV RNA test determines whether the virus is still present. Both results together give the answer, so it is worth confirming that the second test was done.
If treatment cures the infection, why would I still need scans?
Because cure addresses the virus, not the scarring it left behind. Cirrhosis itself carries ongoing liver cancer risk. Studies show a cure cuts liver cancer risk by roughly 71 to 79 percent. It does not remove the risk. That is why guidelines advise six-monthly surveillance in people with cirrhosis.
I do not have cirrhosis. Do I need surveillance after cure?
Generally not. Guidelines recommend against routine liver cancer surveillance after cure for people with stage 3 fibrosis but no cirrhosis, and it is not recommended for those with less fibrosis. What matters is the fibrosis stage recorded in your notes, which is worth confirming with your clinician.
What else raises my liver cancer risk on top of hepatitis C?
Alcohol, hepatitis B co-infection, fatty liver disease, diabetes, obesity, and smoking all add to it. These matter more, not less, after cure, because they continue acting on a liver that has already been through something.
Questions to ask your doctor
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Written by: Cancer ExplainedSources last checked: 2026-08-13 what this meansLast updated: 2026-08-18Next planned review: 2027-07-30
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Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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