Stanford Report, May 23, 2001

BY GRACE HAMMERSTROM

There is a silent killer among Asian and Pacific Islander Americans, one that's asymptomatic and deadly if left undiagnosed and untreated. It's the hepatitis B virus, a virus mainly transmitted by blood, which can cause lifelong infection, scarring of the liver (known as cirrhosis), liver cancer and liver failure. Hepatitis B accounts for 80 percent of all liver cancer cases. To break the cycle of infection that has plagued these communities, the Stanford Asian Liver Center is launching the Jade Ribbon campaign -- a health education effort aimed at Asian and Pacific Islander Americans throughout the Bay Area.

While the incidence of chronic hepatitis B in the majority of the U.S. population is less than 1 in 200, its incidence is 1 in 10 among Asian Americans. In fact, nearly half of the roughly 1.25 million chronic hepatitis B carriers in the United States are Asian Americans. Even more alarming is the fact that one out of four hepatitis B carriers will eventually die of chronic liver failure or liver cancer, making primary liver cancer the fourth-leading cause of cancer for Chinese Americans.

"The greatest single health disparity between Asian Americans and white Americans is liver cancer," said Samuel So, MD, director of the Asian Liver Center. "The incidence of liver cancer in men is seven to 13 times higher in Asian and Pacific Islander Americans than in white Americans." This incidence is directly correlated to the disproportionately high rate of chronic hepatitis B in the Asian and Pacific Islander American populations.

In 1996 So established the Asian Liver Center to address the high incidence of hepatitis B and liver cancer in Asians and Asian Americans. The center is the only nonprofit organization in the nation to take on this challenge, So said.

"Hepatitis B is endemic in Asian countries, where up to 20 percent of the population in some Pacific Rim countries are hepatitis B carriers," said So, who is also an associate professor of surgery and directs the Stanford Multidisciplinary Liver Tumor Clinic.

Though healthy adults infected with hepatitis B are usually able to clear the virus from their bodies, infected children often remain carriers for the rest of their lives. "Infants and children who become infected have the highest risk of becoming hepatitis B carriers," said So. "The risks are 90 percent with perinatal infection, and 30 to 60 percent when children between ages 1 and 5 become infected." As carriers of the virus, they remain infectious to others.

Many immigrants to the United States are unaware they became hepatitis B carriers in childhood and are now at risk of developing liver cancer and passing the infection on to their children at birth. Though not transmitted through casual contact such as sneezing or holding hands, the virus can spread easily through more intimate contact typical of people who live together. For example, sharing toothbrushes and razor blades can spread the virus among household members.

Exacerbating the high incidence of hepatitis B infection among Asian and Pacific Islander Americans is the low rate of vaccination for their children -- only 50 percent. What's more, only 20 percent of teenagers in these communities have been vaccinated. Yet vaccinating against hepatitis B can prevent liver cancer, So said.

"Most people who are hepatitis B carriers don't have symptoms," said So. Even people with early liver cancer experience no symptoms. By the time symptoms appear, the patient is often at a late stage of liver cancer when the prognosis is not good. If symptoms do occur, they can include jaundice, fatigue, abdominal pain, loss of appetite, nausea, vomiting and joint pain. The only way to improve the outcome with liver cancer is through early diagnosis.

The mission of the Jade Ribbon campaign is to increase awareness of hepatitis B and to urge Asian Americans to:

o Get tested for hepatitis B. Asian Americans should ask their doctors for the hepatitis B surface antigen test (HBsAg), which is not in standard blood tests taken at routine exams.

o Get vaccinated against hepatitis B. Individuals who test negative for hepatitis B and newborns should be vaccinated against the disease.

o Get screened for liver cancer. Individuals who test positive for hepatitis B should be regularly screened for liver cancer beginning at age 30.

o Get treated for hepatitis B. There is no cure, but early treatment can reduce the risk of further liver damage. Treatment may include interferon, lamivudine or newer antiviral drugs.

So and his Asian Liver Center colleagues launched the campaign this month in conjunction with Asian Pacific American Heritage Month. Eighty community agencies as well as the Centers for Disease Control, the National Hepatitis B Task Force and the U.S. Department of Health and Human Services are working with the center to coordinate and carry out the campaign.

"There has never been a movement like this that unites all the ethnic groups within the highly diverse Asian and Pacific Islander American community," said So.

Together, these agencies and community partners will be distributing awareness ribbons and health information brochures throughout the Bay Area.

The center has also developed a series of public service announcements intended primarily for broadcast on Asian television networks. They feature two internationally known actors: Chow Yun Fat, star of the Academy Award-winning film, "Crouching Tiger, Hidden Dragon," and May Chin, star of "The Wedding Banquet," who discovered she is a hepatitis B carrier only after being diagnosed with liver cancer two years ago.

"If we don't have a campaign to raise awareness, people will keep dying," said So, who continues to see five or more new cases of liver cancer in his clinic each week.

For information, call the jade ribbon campaign's hotline at (650) 72-LIVER or visit the center's Web site at http://liver.stanford.edu.