A silent killer is on the rise among Asian Americans and Pacific Islanders. As high rates of chronic hepatitis B, a leading cause of liver cancer, continue to afflict the burgeoning population, some experts predict a surge in liver cancer for these ethnic groups in the U.S. during the next 20 years.
Liver cancer incidence is unevenly skewed within the American population, as the disease tends to strike people of certain ethnic groups more often. A recent study from the Journal of Clinical Oncology projects that the number of new liver cancer cases among Asian Americans will jump by 134 percent compared to an increase of 28 percent among non-Hispanic whites by 2030.
The main culprit for this disparity is the prevalence of hepatitis B virus (HBV) in Asian Americans, which infects the liver and typically passes from mother to infant during birth, according to Moon Chen, a professor of public health sciences at UC Davis and principal investigator of the Asian American Network for Cancer Awareness Research and Training.
Chen explained that the majority of Asian Americans are first or second generation immigrants from countries where HBV infections are more common than in North America, and where policies to prevent spread of the virus from mothers to children are absent.
In its chronic form, which develops in up to 90 percent of infected newborns, the disease may go unnoticed for many decades until symptoms manifest as liver damage, liver failure or liver cancer. Federal U.S. guidelines recommend screening all pregnant women and giving children a series of shots shortly after birth to provide lifelong protection against the virus.
“If we can emphasize the birth dose to make sure that when infants are born they get vaccinated and that during prenatal care that mothers are also screened for HBV, then that really is the foundation of the prevention efforts,” Chen said.
According to Ada Yue, coordinator for the Perinatal Hepatitis B Prevention Program of Santa Clara County, annual rates of mother-to-newborn HBV transmission have dropped sharply in the county since the program began in 1991. The program provides collaborative education and support to ensure infants born to infected mothers receive timely vaccination and follow up screening. Still, only 50 percent of infants born to HBV positive mothers are identified for preventive treatment.
“The problem lies in the physician as lack of knowledge in hepatitis B prevention and lack of compliance in reporting,” Yue said.
“Doctors‘ knowledge about HBV, especially in the Asian community, is pretty poor overall,” said physician Stephanie Chao who, along with Yue, has studied the issue as part of ongoing research at the Asian Liver Center at Stanford University.
Chen and Chao agree that promoting widespread vaccination among Asian Americans is only part of the challenge.
The vaccine by itself will not prevent the disease in people who already have chronic HBV, which affects as many as 1 in 10 Asian Americans compared to 1 in 1000 in the non-Asian U.S. population. However, regular screening for liver damage and cancer can help manage the disease in its early stage, which is why HBV status awareness is crucial for appropriate care to reduce unnecessary death rates from liver cancer.
“The perinatal program should in time reduce the liver cancer burden, but the bigger chunk of people that we deal with is the foreign-born population and [the concern is] how do we get them tested and protected,” Chao said. “The next step to actually reach the majority of the Asian population in the U.S. is to get the word out so that people will go to their doctors and get screened and tested for HBV.“
One strategy that works is providing education and outreach in their native language rather than only in English, Chen said. As part of various outreach efforts, AANCART, a cooperative agreement between UC Davis and the National Cancer Institute, developed a website for health care providers and advocates to quickly find relevant cancer education materials in Asian and Pacific Islander languages.
“We’re very fortunate that we have people at the policy level, at the care level and at the research level who are trying to reduce the burden of this disease,” Chen said.
ELAINE HSIA can be reached at email@example.com.