5 questions: Samuel So on hepatitis B

Samuel So

If enacted, the National Hepatitis B Act, introduced in Congress in December, would allocate research funding for this disease, which affects one in 10 Asian-Americans and frequently causes liver cancer. It was conceived by Samuel So, MD, the Lui Hac Minh Professor of Medicine and director of both the Asian Liver Center and the Liver Cancer Program, with the help of congressmen Michael Honda (D.-Calif.) and Charlie Dent (R.-Pa.). Medical Center Report asked So to discuss his efforts to combat the disease.

1. Do we need a bill to raise awareness of hepatitis B?

So: People don't realize that hepatitis B is spread the same way as HIV—from mother to child at birth, through contaminated blood products such as blood transfusions, infected needles or syringes and through unprotected sex. Yet because hepatitis B can exist in the external environment for up to seven days, it is 100 times more infectious than HIV. The public doesn't realize that there are about twice as many people living with chronic hepatitis B than with HIV in the United States and that worldwide a million people die annually from liver cirrhosis or liver cancer caused by chronic hepatitis B. It is second only to smoking tobacco as the major cause of cancer in the world.

What's troubling is that there are effective interventions for those who are suffering from chronic hepatitis B, but doctors don't routinely test their Asian patients for it. Many physicians are not aware how common chronic hepatitis B is in the Asian community, so they do not routinely do a one-time, $10 to $20 blood test to check for it. And if diagnosed, there are very effective antiviral therapies as simple as a pill a day that can help to suppress the virus and reduce the risk of liver cancer and liver cirrhosis.

2. How widely has it affected Asian-Americans?

So: I think this disease has touched the lives of most Asians and Asian-Americans. For instance, my own wife's mother died of liver cancer caused by chronic hepatitis B. The chances are, if you talk to four Asians, one will tell you they know of someone who died of liver disease or liver cancer caused by chronic hepatitis B.

Chronic hepatitis B is recognized as a major health disparity between Asian-Americans and non-Asian-Americans. If you are a foreign-born Asian-American pregnant woman, you have a 9 percent chance of having chronic hepatitis B compared with a 0.1 percent chance for a pregnant Hispanic-American or Caucasian-American.

3. Why does the bill have provisions calling for research on treating liver cancer?

So: The goal isn't only to reduce the incidence of liver sickness but also to improve the survival of people who develop liver cancer due to chronic hepatitis B infection.

Liver cancer caused by hepatitis B is one of the deadliest cancers. Through improved methods for early detection and screening we could improve survival rates. We also need to find a more effective treatment because at present there's no effective systemic chemotherapy for liver cancer.

What's so tragic is that it's largely preventable. The World Health Organization calls the hepatitis B vaccine the first anti-cancer vaccine.

4. If there's a vaccine for the disease, why does it remain so prevalent?

So: Even though we have had a very safe and effective vaccine for a number of years we are not implementing an effective vaccination program worldwide to eliminate this infection. This is one of the reasons why at the Asian Liver Center, we are helping countries in Asia to develop effective vaccine programs.

Hepatitis B brings up one of the vexing issues we have in modern medicine: the giant gap between what we have discovered and what we have implemented. Here we have had a vaccine for more than 25 years that could prevent liver cancer, and we are not giving it to everyone in the world to prevent this deadly disease.

5. What's the role of the Asian Liver Center in the fight against hepatitis B?

So: We are a nationally and internationally known center for research in liver cancer, particularly in liver cancer genomics as well as investigating novel blood markers for the diagnosis of liver cancer. We've published the first genome-wide analysis of liver cancer, leading to the identification of better prognostic markers for that disease. We remain the only organization in this country that specializes in addressing this major health disparity between Asian-Americans and non-Asians.