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Hepatitis B

Some People with Hepatitis B May Need Liver Cancer Screening Sooner and More Often

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Asian immigrants in the U.S. who have chronic hepatitis B virus (HBV) infection may develop hepatocellular carcinoma (HCC) at younger-than-expected ages, suggesting that people with risk factors such as smoking and family history should start liver cancer screening sooner and receive it more frequently, according to a report in the September 13, 2011, advance edition of the American Journal of Gastroenterology.

Over years or decades, chronic hepatitis B (and C) can lead to serious liver damage including cirrhosis and HCC. In the U.S., hepatitis B is much more prevalent among people from Asia, where HBV is endemic and many people became perinatally infected before the advent of widespread vaccination.

HCC is more easily treated if caught early. Routine liver cancer screening is recommended for chronic hepatitis B patients with cirrhosis and certain for high-risk populations -- including Asian men age 40 and older and Asian women age 50 and older -- even if cirrhosis is not present. However, many younger hepatitis B patients develop HCC before they are advised to start screening.

David Wan from New York University and colleagues aimed to determine risk factors for the development of early-onset HCC -- that is, occurring in men under age 40 or women under 50 -- among U.S. Asian immigrants with chronic hepatitis B.

The investigators retrospectively collected clinical, demographic, and laboratory data for all Asian immigrants with hepatitis B at Bellevue Hospital Center in New York between 2003 and 2009. A total of 168 patients with HCC were identified and compared with age-matched control subjects with hepatitis B but not HCC.

Results

  • 74% of all identified HCC cases (124 out of 168) were late-onset, while 26% (44 out of 168) were early-onset.
  • In a comparison of the 124 late-onset HCC patients with 199 age-matched control subjects without HCC, the following factors were found to be significantly (P < 0.05) associated with liver cancer development:

o      Male sex: odds ratio (OR) 4.4, or more than a 4-fold risk;

o      Liver cirrhosis: OR 9.6;

o      Surrogate marker lab tests (i.e., platelets, international normalized ratio, total bilirubin, albumin).

  • Comparing the 44 early-onset HCC patients with 432 age-matched control subjects with hepatitis B, the following were independent (P < 0.05) predictors of liver cancer:

o      Male sex: PR 2.7, or nearly a 3-fold risk;

o      Family history of HCC: OR 2.7;

o      History of smoking: OR 3.4.

o      Liver cirrhosis: OR 19.5;

o      Surrogate marker lab tests.

  • Overall, 54.8% of people with late-onset HCC had cirrhosis, compared with 29.5% of early-onset HCC cases.

"HCC occurs in Asian immigrant HBV patients younger than currently recommended screening guidelines," the study authors concluded. "A large majority of these early-onset patients did not have cirrhosis at the time of their HCC diagnosis; therefore, factors other than cirrhosis need to be considered when evaluating HCC risk in young patients."

"Factors associated with HCC development across all ages include cirrhosis and male gender, while family history and smoking history may identify younger Asian immigrant HBV patients at risk for HCC," they continued. "[O]ur results suggest that younger Asian HBV patients, especially those with a smoking history or family history of HCC, appear to have an increased risk for HCC and should be considered for enrollment in early screening programs regardless of their age."

Investigator affiliations: Division of Gastroenterology, Department of Medicine, New York University Langone Medical Center, New York, NY.

11/4/11

Reference

DW Wan, D Tzimas, JA Smith, et al. Risk Factors for Early-Onset and Late-Onset Hepatocellular Carcinoma in Asian Immigrants With Hepatitis B in the United States. American Journal of Gastroenterology (abstract). September 13, 2011 (Epub ahead of print).