Why Is Liver Cancer More Lethal for Black Patients?
Black people with hepatitis C develop liver cancer sooner than people in other racial groups and the cancer is often more aggressive, but current screening guidelines may not be broad enough to catch these cases early, according to a new study.
Why? Despite often being more advanced, liver cancer in Black people is slower to cause liver damage and scarring, and current guidelines call for liver cancer screening only after such scarring (cirrhosis) has occurred, researchers said.
"Not only is the cancer more aggressive, but we are also not picking it up at the same point in time as we do for other populations," explained study author Dr. Umut Sarpel, an associate professor of surgery and medical education at the Icahn School of Medicine at Mount Sinai in New York City. "Providers in this arena say that until you develop cirrhosis, you're fine, but this study tells us that is not really true for everyone."
While rates of many other cancers are going down, liver cancer is on the rise, 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, which can lead to liver cancer.
Researchers reviewed the medical records of nearly 1,200 people with hepatitis C and liver cancer who were treated at Mount Sinai Medical Center. Of these, 390 were Black.
At the time that their liver cancer was diagnosed, Black people with hepatitis C also had larger liver cancers with more aggressive features, yet little to no scarring, Sarpel said.
Nearly one-third of Black patients in study would not have qualified for liver cancer screening using common cirrhosis measures, she said.
Exactly why tumors are more aggressive is not fully understood yet, but researchers are working on it. This could be related to genes, lifestyle or access to care, Sarpel said. Similar disparities have been seen in other cancers, including triple-negative breast cancer, she said.
Current guidelines should be changed to catch liver cancer earlier, Sarpel said: "If you are Black and have hepatitis C, let's not wait for cirrhosis to screen 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 to get them into screening sooner," Sarpel said.
The findings were published Feb. 25 in the journal Cancer.
The findings have important implications for liver cancer screening in the Black population, said Dr. Mark Yarchoan. He is an assistant professor of medical oncology at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore.
"Current screening guidelines designed to intercept liver cancer at an early stage in patients with liver disease may be missing liver cancer in a high number of Black patients," said Yarchoan, who was not involved in the new study.
Still, some questions remain, he said. "We don't know whether there is something inherent to these liver cancers that make them more aggressive, or if the data are reflective of higher rates of other comorbidities such as diabetes in this population of patients, or whether these results reflect barriers to accessing health care," Yarchoan noted.
"Getting to the bottom of 'why?' will be critical for improving outcomes for Black patients, and potentially for other patients with liver cancer as well," he said. Then, Yarchoan said, screening guidelines and cancer therapies can be further optimized for all patients at risk for liver cancer.
Learn more about hepatitis C at the U.S. Centers for Disease Control and Prevention.
SOURCES: Umut Sarpel, MD, associate professor, surgery and medical education, Icahn School of Medicine, Mount Sinai, New York City; Mark Yarchoan, MD, assistant professor, medical oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore; Cancer, Feb. 25, 2021