From Denise Mann
HealthDay reporter
THURSDAY, February 26, 2021 (HealthDay News) – Black people with hepatitis C develop liver cancer earlier than people in other race groups and the cancer is often more aggressive, but current screening guidelines may not be broad enough to detect these cases early. according to a new study.
Why? Although liver cancer is often more advanced in black people, it is slower to cause liver damage and scarring, and current guidelines do not require liver cancer screening until after such scars (cirrhosis) appear.
“The cancer is not only more aggressive, but we also do not ingest it at the same time as in other population groups,” explained study author Dr. Umut Sarpel, Associate Professor of Surgery and Medical Education at the Icahn Medical School on Mount Sinai in New York City. “Providers in this area say you will be fine until you develop cirrhosis, but this study tells us that not everyone does.”
While the rate of many other cancers is falling, liver cancer is increasing, according to the U.S. Centers for Disease Control and Prevention. Hepatitis C infection is the main risk factor for hepatocellular carcinoma (HCC), the most common type of liver cancer in adults. Hepatitis C can cause cirrhosis of the liver, which can lead to liver cancer.
The researchers reviewed the medical records of nearly 1,200 people with hepatitis C and liver cancer who were being treated at Mount Sinai Medical Center. Of these, 390 were black.
At the time their liver cancer was diagnosed, blacks with hepatitis C also had major liver cancers with more aggressive features but little to no scars, Sarpel said.
Almost a third of the black patients studied would not have qualified for liver cancer screening with standard cirrhosis measures, she said.
Why tumors are more aggressive is not fully understood, but researchers are working on it. This could be related to genes, lifestyle, or access to care, Sarpel said. Similar differences have been seen in other cancers, including triple negative breast cancer, she said.
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The current guidelines should be changed to help develop liver cancer earlier. Sarpel said, “If you’re black and have hepatitis C, we don’t wait for cirrhosis to be screened for liver cancer.”
Liver cancer screening typically involves an ultrasound of the liver. “In the future, genetic markers or a blood test may help identify people at high risk earlier and get them screened earlier,” said Sarpel.
The results were published in Cancer magazine on February 25th.
The results have important implications for liver cancer screening in the black population, said Dr. Mark Yarchoan. He is Assistant Professor of Medical Oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore.
“Current screening guidelines that aim to catch liver cancer early in patients with liver disease may be absent in high numbers of black patients,” said Yarchoan, who was not involved in the new study.
Still, some questions remain, he said. “We don’t know if there is something inherent in these liver cancers that makes them more aggressive, or if the data reflect higher rates of other comorbidities such as diabetes in this patient population, or if these results reflect barriers to accessing health care,” Yarchoan noted.
“To the reason of ‘why?’ will be critical in improving outcomes in black patients and possibly other liver cancer patients, “he said. Then, says Yarchoan, screening guidelines and cancer therapies can be further optimized for all patients at risk of liver cancer.
More information
Learn about hepatitis C at the US Centers for Disease Control and Prevention.
SOURCES: Dr. Umut Sarpel, Associate Professor of Surgery and Medical Education at the Icahn School of Medicine at Mount Sinai in New York City; Mark Yarchoan, MD, Assistant Professor, Medical Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore; Cancer, February 25, 2021
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