The longer we have hepatitis B, the higher our risk of developing liver cancer. With every decade of life, our liver cancer risk increases 2.7-times, according to a report on Viral Hepatitis in the Elderly published in the American Journal of Gastroenterology.
But current medical guidelines don’t spell out exactly when liver cancer testing should begin in many hepatitis B patients who don’t have liver damage (cirrhosis) or a family history of liver cancer, and are not of Asian or African descent.
Age is clearly an important factor when it comes to liver cancer, “… but current guidelines only provide age-specific recommendations for (liver cancer) surveillance in hepatitis B carriers of Asian ethnicity (men over age 40 and women over age 50),” a team of University of Miami and Veterans Affairs researchers wrote in the journal article.
Current medical guidelines are clear that anyone with cirrhosis (liver scarring) should be screened twice a year or more frequently for liver cancer, using ultrasound examinations and an alpha fetoprotein (AFP) test, which is a blood test that is moderately successful at identifying cancerous tumors. There’s good reason for this mandate–about 80 percent of people diagnosed with liver cancer also have cirrhosis.
The guidelines also state that patients who have a family history of liver cancer, are co-infected with HIV or hepatitis C or who are young males of African descent should also be tested for cancer at any age.
But many of us don’t have those “risk factors,” including cirrhosis, but we are still at risk of liver cancer because we’ve had hepatitis B for decades. Our liver cancer risk is much lower than if we have cirrhosis, but it’s still there.
As doctors debate whether these guidelines should be changed to promote earlier screening, here are some questions to review with your doctor to determine if you should be screened for liver cancer:
How many years have you had hepatitis B? The longer you’re infected, the higher your risk of liver cancer. Men of African descent are found to develop liver cancer at an earlier age than other races and should be screened starting in their 20s.
What is your gender? Men are considered at higher risk of liver cancer at an earlier age because they may be more likely to smoke, drink alcohol, have more “active” hepatitis, and higher iron stores—all of which increase cancer risk. Estrogen is believed to protect pre-menopausal women against liver cancer.
Have you had a high viral load (HBV DNA) after age 30? Having a viral load exceeding 2,000 international units per milliliter (IU/mL) is associated with a higher risk of liver cancer even if you have no other signs of liver damage.
Do you have a family history of liver cancer? If an immediate family member has had liver cancer, this greatly increases your risk.
Are you overweight, or have you been diagnosed recently with type 2 diabetes? A fatty liver and/or diabetes increase your risk of liver cancer dramatically when you’re also infected with hepatitis B.
Do you have hepatitis B virus genotype C or core/precore viral mutations? Originating in Asia, this hepatitis B strain is associated with loss of the hepatitis B e antigen (HBeAg) later in life. That means you may have had a high viral load and liver damage for a longer period than people with genotypes who clear HBeAg at a younger age. Having core or precore mutations in your HBV also increase liver cancer risk.
Talk to your doctor, even if you haven’t had liver damage and have had a low viral load or undetectable viral load for many years, ask if it’s time for a liver cancer test. For more information about liver cancer visit the Liver Cancer Connect website and for more information about screening for liver cancer, click here.