A new study seeking detailed information about the ongoing increase in liver cancer in the U.S. found racial and ethnic differences in the outcomes.
Studies had already shown the rates of liver cancer among blacks and Hispanics are nearly double that of Caucasians, and their mortality rates are also higher.
However, Dr. Amit Singal of UT Southwestern Medical Center waned to know more.
“But those studies actually don’t have granular data on several factors that you would think would be important,” he said, “like liver function, tumor stage, and access to care.”
Singal and other researchers studied records of 1,100 patients diagnosed at Parkland and UT Southwestern Medical Center (mostly male, about a third each white, black and Hispanic). They found racial and ethnic differences in outcomes: Blacks and Hispanics less likely than whites to get early diagnosis and curative treatment, and blacks less likely to survive.
Singal says much of this stems from lack of access to screening for the disease.
Lack of access to screening: We’re (doctors) trying to do more and more in a shrinking amount of time when we see patients, and sometimes when you take a look at the priority items that you have to take care of during that short visit, this falls off that list as you take care of other things.
The other things is, particularly in patients with liver disease, these patients can be sick at times, and so as you take care of those more acute issues, you forget to do the screenings.
The Hispanic paradox: This is the first time this has been shown in liver cancer. When you take a look at the survival initially, it looks as if Hispanic patients have similar survival to Whites. However, when you account for several other factors, Hispanics actually had significantly better survival.
We don’t know exactly why the Hispanic Paradox exists. There are several different theories. Some people think this could be related to different social factors like differences in eating habits, differences because of social support. Others believe this could differences in biological behavior between the race ethnicities.
Diagnosis in later stages: Liver cancer is really driven by two different factors: The cancer and then there’s the sick liver in which it occurs. When you look at these different race and ethnicities, it seems like the prognosis is really being driven different factors. In Hispanics, it’s being driven by the liver disease, more so than by the cancer at times. Whereas in Blacks because the liver is healthier, it’s really driven by the cancer burden.
Treatment in later stages: It’s important to consider and treat both of those factors. For example, the most common form of liver disease in blacks is underlying hepatitis C. We now have very effective therapies for hepatitis C, and so it's very important that we are very aggressive in treating that underlying liver disease. For Hispanics, the underlying liver disease is more commonly related to non-alcoholic fatty liver disease. There are currently no effective therapies. Many companies are doing research to find effective therapies. If we can find something, this may be something that will improve prognosis in the future.
Another reason for lack of care for blacks and Hispanics: I think a lot of this relates to the overlap between race ethnicity and socio-economic status. Racial ethnic minorities tend to have lower socio-economic status which may limit their access to care.
What blacks and Hispanics can do to lower risk of liver cancer: Baby boomers born between 1945 and 1965, or those at risk for the disease, should get screened for hepatitis C. Otherwise, lead a healthy lifestyle: Eat a healthy diet and exercise to prevent fatty liver disease and liver cancer.
- Diagnosis and treatment of HCC varies by race
- Racial and Ethnic Differences in Presentation and Outcomes of Hepatocellular Carcinoma
- Incidence of Hepatocellular Carcinoma in All 50 United States, From 2000 Through 2012
Interview responses have been lightly edited for clarity and length.