Informed Patient Conference 2006
June 10-11, 2006, Stanford California
Making the Link: Hepatitis B and Liver Cancer
Dr. Sam So, MD, FACS, The Lui Hac Minh Professor, Stanford University Medical Center, and Founder and Director, Asian Liver Center at Stanford University
As the keynote presenter at the 6 th Annual B Informed Patient Conference, Dr. Sam So, re-titled his presentation, “Scream If You’re Not Getting Screened Regularly for Liver Cancer” to emphasize that there is a strong link between the hepatitis B virus (HBV) and liver cancer, which is the fastest growing cancer in the United States.
Below is a summary of the highlights of Dr. So’s presentation.
First some important facts…
- Worldwide, 400 million people with chronic HBV vs. 40 million people with HIV
- 1 in 4 individuals with HBV will die of liver cancer, cirrhosis or liver failure
- 1 million lives are lost each year due to HBV
- A vaccine to prevent HBV has been available for more than 25 years
Remember, hepatitis B transmission is not “BS”, but “ BBS” – that is, blood, birth, and unprotected sex. Many people do not realize that most people in the world are infected at birth by their mothers who do not know they have chronic HBV.
HBV is NOT transmitted through sharing food, drinks, casual contact, sneezing or kissing (“unless you routinely bite someone while kissing”).
Connecting the dots between HBV and liver cancer…
Dr. Palmer Beasley was the first to conduct a large study of more than 22,000 Taiwanese government workers. He discovered that the risk of liver cancer was 60 times greater in those with chronic HBV vs. those who are uninfected. This is a much higher association than lung cancer and smoking, which is about 20-25 times greater in smokers vs. non-smokers.
In 1997, Taiwan reported a significant drop in liver cancer rates in children after universal infant HBV immunization programs were adopted.
In 2005, the United States Food and Drug Administration added HBV to its small list of 58 known cancer-causing agents (e.g. carcinogens).
The World Health Organization designated the HBV vaccine as the first “anti-cancer” vaccine (contrary to media reports about the HPV vaccine being the first).
HBV is second, only to tobacco and lung cancer, as a known cause of cancer!
HBV in China
If one were to believe the media in China, then it would seem that HIV was the most important public health problem. In fact, hepatitis B is an enormous problem with 130 million Chinese infected with HBV (10% of total population) versus 650,000 infected with HIV (0.05%).
In addition, with 12 reported deaths due to avian flu last year, the Chinese government has responded by recommending the vaccination of every bird against avian flu! But isn’t it more important to vaccinate every person against hepatitis B, which is a much more real threat and danger?
HBV in the USA
The greatest health disparity between Asian Americans and Caucasians is chronic HBV and liver cancer:
- 1 in 10 Asian Americans have chronic HBV
- 1.2-1.4 million Americans have chronic HBV, and 60% are Asian Americans
- Risk of liver cancer is 4-13 times greater for Asian Americans than Caucasians
- Liver cancer is the 2 nd leading cause of cancer among Asian American males
- The 5-year survival rate for liver cancer is only 7% vs. 87% for breast cancer
- Liver cancer is the fastest growing cancer in the United States
Physicians are unfortunately themselves not aware that HBV is a huge public health problem among
Asian Americans and that it is the primary cause of liver cancer. This lack of awareness and understanding was confirmed by the results of a survey of incoming house staff at Stanford University Medical Center in 2003, which reflects national figures:
- Only half were aware HBV is a major health problem among Asian Americans (53%)
- Less than half recognized perinatal transmission as the major mode of transmission among Asian Americans (40%)
- Only a quarter knew about the increased risk of liver cancer from chronic HBV (27%)
- Only a quarter would order HBV screening for their Asian American patients (27%)
Screening for chronic HBV patients
Screening for Liver Damage : Every 6 months blood tests for ALT and HBV markers should be monitored (or more frequently if needed)
Screening for Liver Cancer : Both of the tests below are very important to for liver cancer screening.
- Add AFP (alpha-feto-protein) to the ALT and HBV blood tests every 6 months (or more frequently if needed)
- Ultrasound the liver at least once a year (twice a year if you have cirrhosis or a family history of liver cancer). For fatty or cirrhotic livers, a Triphasic CT provides a clearer image than ultrasounds.
Remember, early detection of liver cancer is critical to increasing successful intervention and survival!
Dr. So’s recommendations in a nutshell . . . “B Informed”
- Know what tests are needed
- Don’t assume all doctors understand HBV and the risk of liver cancer
- Don’t let your doctors scare you!
- Change doctors if they won’t order the right tests
- Get your family tested and vaccinated
With a few simple tests at least twice a year, you too can live a healthy long life!
Dr. So invited Richard to share his story about liver cancer…
“One winter Monday morning, my number one priority was to complete a major project at work. After receiving my blood test results later that evening, my top priority on Tuesday morning was to save my life,” so began Richard in his emotional and compelling story that emphasized the urgent need for regular liver cancer screening.
Four years ago, Richard was diagnosed with chronic HBV during a routine physical and was seen by a liver specialist. His AFP blood test was 18, but neither he nor the doctor was very concerned. “I had a false sense of security and was more concerned about GI cancer and colonoscopies due to all the media attention,” he said. “I became complacent and didn’t follow-up with regular appointments.”
In January 2006, the doctor discovered that Richard had a 10 cm liver cancer tumor. After undergoing two difficult chemo-embolization treatments, his liver tumor has shrunk to 7 cm. But it’s not yet clear whether a liver resection or transplant will be necessary.
“I’m fighting for my life now. It’s very emotional and very hard on my family. I don’t know what the result will be, but I’m doing everything possible to qualify for the liver transplant list, in case that’s my best option.”
Richard is not only fighting for his life, but is also hoping to save other lives by publicly telling his story. “I’m sharing my story because prevention is so much better than waiting until treatment is too late. Everyone should be proactive, get tested and screened regularly for liver cancer. Don’t wait!”