Liver Cancer Screenings Need to Change for Black Americans: Here’s Why

• In a new study, researchers say liver cancer tumors appear to be larger in Black patients.
• They also note that many times, liver cancer develops in Black Americans before the onset of hepatitis C.
• The researchers recommend that liver cancer screening guidelines be modified for the Black community.
• They say new screening procedures could produce earlier treatments and save lives.

Researchers are calling for a change in the screening guidelines of liver cancer for Black Americans.

They believe earlier intervention could save more lives.

The recommendation comes out of a study published Feb. 25 in the American Cancer Society journal Cancer.

Researchers at New York’s Mount Sinai hospital conducted a retrospective study of 1,195 people who developed liver cancer after having hepatitis C. About 390 of those patients identified as Black.

There were two major findings from the research.

“First, the tumors in Black patients were worse; more aggressive. They were higher grade, more likely to invade the blood vessels. They were what we call ‘worse actors,’ which can lead to worse outcomes,” said Dr. Umut Sarpel, the study’s lead author and a cancer surgeon and associate professor of surgery and medical education at the Icahn School of Medicine at Mount Sinai.

“The other thing we found was more surprising to me,” Sarpel told Healthline. “We think of liver cancer developing after hepatitis C has run its course and caused cirrhosis. That’s when we would start screening for liver cancer.”

“But in one-third of the Black patients in our study, their tumors arose before cirrhosis. That means the current screening guidelines failed a third of the Black patients in our study. That means they don’t serve that community well,” she explained.

Reaction to the study

“It’s an important paper that shows we need to think outside the box a bit,” said Dr. William G. Cance, the chief medical and scientific officer at the American Cancer Society.

“The good thing here is that the researchers argue for a change in practice immediately,” he told Healthline. “We can look at starting surveillance earlier, using ultrasounds or scans, not waiting for the fibrosis.”

“The questions the Mount Sinai investigators asked are very important,” added Dr. Yuman Fong, a surgical oncologist as well as chair and professor in the department of surgery at the City of Hope in Los Angeles.

“The reason this is important is because hepatitis C is one of the silent killers in America. Patients may have no symptoms whatsoever,” Fong told Healthline. “African Americans have a higher rate of getting hepatitis C than other groups in America.”

Earlier intervention

“If we find liver cancer very early, we can treat it with much less invasive therapy,” said Fong.

“If we find a little tumor in somebody’s liver, meaning something less than an inch in size, many times we can either cut it out robotically or we can put a needle through it,” he explained. “Then, under some sort of scanning guidance we can burn it by using microwave energy or radio frequency.”

Early detection also has an impact on liver transplantation.

“An African American patient is less likely to be transplanted because liver transplantation in this country is guided by the stage of the disease,” noted Fong.

“We only transplant patients when the tumors are highly likely to be cured, meaning they’re small, and there’s no sign of spread,” he added.

Antivirals as game changers

“The effect of the hepatitis C drugs, which have come around the past 10 years, is one of the biggest advances we’ve had,” Cance said.

“Hepatitis C is now potentially curable. We have medications that we can give patients that have a 90 percent chance of curing the patient of virus,” added Fong.

“The reason it’s possible to do that is because hepatitis C lives in the substance of the cell, but not in the nucleus where the genetic material is,” he explained. “Therefore, all you have to do is stop the virus from replicating and let the cells that have the viral infection die off.”

“That’s why I try to make sure that our African American patients also get equal access to hepatitis C treatment,” Fong added.

Next steps

The researchers say more study is needed to understand why Black participants in the latest study had a more aggressive form of the cancer.

“Ultimately… the most sophisticated way of doing this is to identify what it is about being Black that seems to be causing this,” Sarpel said. “Is it genes?”

“Studies need to look into why and whether there is a particular treatment that might be more suited for that type of cancer,” she added. “It’s important and helpful and could save lives.”

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