CYP3A4 and hepatocellular carcinoma: Altered ESR1 expression is associated with development of hepatocellular carcinomas [7,8], and is related to the sexually dimorphic nature of several liver diseases, for example, hepatocellular carcinomas [9], nonalcoholic fatty liver disease [6,10,11], and liver gene expression [12] including the cytochrome P450 (CYP) drug metabolizing enzyme CYP3A4 [13].