The hidden virus

liver411

San Francisco Chronicle



THE SAN FRANCISCO CHRONICLE



The hidden virus

Doctors try to alert Asian, Pacific Islander Americans to increased risk of liver cancer,



Author:

Ryan Kim;  



Chronicle Staff Writer





Edition: FINAL

Section: NEWS

Page: A11



Index Terms:

hepatitis B

Asian Liver Center at Stanford University

Jade Ribbon Campaign

Mark Lim

ASIAN-AMERICANS

DISEASE

HEALTH

RESEARCH



Estimated printed pages:

4



Article Text:

As a general internist, Mark Lim was aware of the deadly link between hepatitis B, which he carried, and liver cancer.



But his medical training did not prevent him from later being diagnosed with advanced inoperable liver cancer. It was only after he was diagnosed that the San Francisco man finally understood one of the greatest health threats to Asian Americans.



"I read about it in articles, but I never really realized that hepatitis B was so predominant in Asians," said Li, 31. "I never drank alcohol. I exercised regularly. This was a total shock."



While hepatitis B shows up rarely among Caucasians in the United States -- it occurs in 0.1 percent of the population -- it is an often deadly reality for many Asian and Pacific Islander Americans like Chiu. As many as 1 in 10 Asian and Pacific Islander Americans carries the virus, accounting for more than half of the cases in the United States.



A quarter of the hepatitis B patients in the country will eventually die of liver cancer or liver failure. The virus causes 80 percent of the liver cancer cases among Asian Americans.



As a result, Asians are up to 13 times more likely to develop liver cancer than Caucasians, according to the Asian Liver Center at Stanford University.



This summer, the Asian Liver Center began an initiative called the Jade Ribbon Campaign to educate Asian Americans and Pacific Islanders about the dangers of hepatitis B and the need for prevention.



The program, which includes advertisements and pitches by celebrities such as actor Chow Yun Fat, is targeted at the fast-growing Asian American community, which remains largely in the dark about hepatitis B.



"This is an example of the big disparities between Caucasian Americans and Asian Americans," said Dr. Samuel So, director of the Asian Liver Center. "This is also an example of why we should pay attention to some of the special health care needs in various ethnic communities."



The high incidence of hepatitis B in the Asian American community traces its roots to Asia, where hepatitis B infection rates reach as high as 15 percent in China, Vietnam and Southeast Asia. The rates hover around 8 to 10 percent in the Philippines and Korea; India and Japan are lower.



Children are the most vulnerable because the virus can pass from mother to child at birth. While vaccines developed in the early '90s ensure that most newborns in America can be protected against hepatitis B if vaccinated within the first 12 hours, actual vaccinations nationwide are administered only about 50 percent of the time for Asian American infants, So said.



Many hospitals are unaware of the need for vaccinating Asian American babies because few have been educated about the high rates of hepatitis B infections among Asian mothers, So said.



Many Asian children are exposed to the by siblings, parents or others who have emigrated recently from Asia without vaccination.



Because the virus, which is present in blood and transmitted through sexual intercourse, is so potent -- 50 to 100 times more infectious than HIV -- people can become infected many ways.



"A young child can wipe their hand across a tabletop where there is a small amount of blood from someone who used the table before," said Gary Euler, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta. "If the table's not cleaned, the virus can be virulent for at least seven days. "



One of the biggest hurdles in fighting liver cancer is that many medical practitioners do not completely understand the need to screen and test Asians for hepatitis B. Those who understand the link between the virus and liver cancer often offer treatment that has been more effective for white patients, who most often contract hepatitis B as adults.



Because the virus takes 20 to 30 years before it leads to cancer, many doctors advise patients to screen for cancer in their 50s and 60s, when most Caucasian liver patients develop symptoms.



"Many doctors think it will hit at 50 but not at 30," Lim said. "I was given the right recommendation, but it was given 20 years too late."



In most cases, adults who become infected with hepatitis can be successfully treated before it causes liver cancer. But because there are few symptoms of chronic hepatitis, children can play unwitting host to the virus, allowing it to mature undetected into cancer, said Dr. Huy Trinh, a liver specialist in San Jose.



"The problem is this is a silent disease, because people don't have symptoms," Trinh said. "eople think it just happens to others and not to them. "



They include people like Edwin Chow, who underwent surgery in July to remove cancerous lesions on his liver. The 45-year-old computer programmer says he's fortunate he was diagnosed in time to get treatments.



"I might have had only a few more months" before it was too late, said Chow, who lives in Albany. "I was feeling great. That's the ironic part about it."



So recommends that Asian Americans be tested for hepatitis B and get vaccinated against the virus, which does not require further booster shots.



Adults should start liver cancer screening at age 30, when the disease can begin. And if possible, patients should undergo treatment for hepatitis B as early as possible, which might include the use of antiviral drugs that reduce further liver damage.



"As a liver specialist, I've seen people who, 80 percent of the time, are not candidates for curative treatment because it's too late," So said. "The cheapest, most cost effective way is to treat this early."



Caption:

(1) At Stanford University's Asian Liver Center, Dr. Samuel So treated Edwin Chow, who had surgery to remove cancerous lesions., (2) So showed San Jose resident Louis Pham, 49, how large the patient's cancer was before being treated by drugs.

Photos by Katy Raddatz/The ChroniclePHOTO (2)



Memo:E-mail Ryan Kim at [email protected] 2001  The Chronicle Publishing Co.

Record Number: 3200818