Turning the Tide of Liver Cancer Among Asians
Tuesday, 25 March '08
UCSF Today
A largely preventable cancer is expected to become more common in the United States in coming years.
No, it’s not lung cancer — the decades-long decline in smoking rates finally is leading to fewer lung cancer deaths.
It’s liver cancer.
“It’s deadly and it’s preventable,” says UCSF investigator Tung Nguyen, MD.
The cause of more than eight in 10 liver cancers in the United States is chronic infection with the hepatitis B or hepatitis C virus. The number of new hepatitis infections is declining. But just as there has been a lag between the decline in smoking and the drop in lung cancers, it may take many years before the trend toward fewer hepatitis cases and better hepatitis treatments leads to fewer liver cancers. Liver cancers arise a few decades after infection, and a few decades ago, hepatitis infections were still on the rise.
Nguyen — who emigrated as a child from Vietnam — is fighting hepatitis in Bay Area Asian communities. Through outreach and training of key community members and through campaigns in ethnic media, Nguyen and his collaborators aim to help reverse the US liver cancer trend as quickly as possible.
Hepatitis B Is Common
Why focus on Asians? Hepatitis B is common in many parts of the globe, including Asia. Because of this, liver cancer is the third most common cause of cancer death worldwide. Immigrants from Asian countries are infected at high rates. So too are their children. For instance, in San Francisco, where according to the 2000 census nearly one in three people is Asian, an estimated one in 10 Chinese is infected with hepatitis B.
Today in the United States, hepatitis C is mainly spread by IV drug users sharing needles, and there is not yet a commercially available vaccine. On the other hand, there are vaccines to prevent hepatitis B infection. The vaccine strategy originated with pioneering research at UCSF. Children in the United States now are routinely vaccinated early, before they mature and become sexually active.
But mothers can easily pass hepatitis B to their children in the womb. This is the major source of existing hepatitis infections in the US Asian community, Nguyen says. In addition, many children who immigrate to the United States miss school vaccinations and risk becoming infected later.
Infection is lifelong. Only a minority infected with hepatitis go on to develop liver cancer. But because so many in Asian communities already are infected at birth, Nguyen explains, some are developing liver cancer in their 30s or even in their 20s. Increasing liver cancer screening among people who test positive for hepatitis is an important outreach goal, Nguyen notes.
Disease Is Often Symptomless
Hepatitis often has no symptoms. “Some people get vaccinated without getting tested first to see if they already have been infected,” Nguyen says. “They think they are protected, when in reality they already may be infected, and infecting others.”
Nguyen is a partner in a San Francisco Department of Public Health program to combat hepatitis B. The aim of “San Francisco Hep B Free” is to screen, vaccinate and treat all Asians and Pacific Islanders who live in the city, in part by providing free or low-cost testing.
Nguyen also is a regional leader in the Asian American Network for Cancer Awareness, Research and Training, and he directs the Vietnamese Community Health Promotion Project. He heads up a new National Cancer Institute-funded educational campaign for Vietnamese in Bay Area counties, which targets the community with messages via radio, television, print publications and online media. Vietnamese in the United States have the highest rate of liver cancer, about 11 times higher than the rate among whites.
To get out the word, it’s best to use individuals who are esteemed in the community, ranging from physicians and local ethnic celebrities to socially connected and specially trained lay health workers who can be effective in persuading people to get screened, vaccinated or treated, Nguyen has found.
“It’s not just the message; it’s who’s delivering the message,” Nguyen says.
Tuesday, March 25, 2008
Tuesday, February 26, 2008
UCSF Today: "HepB Free Project joins with UCSF staff to Offer Prevention Strategies to Community"
First Appeared Tuesday, 26 February '08 UCSF Today
By Shipra Shukla
Free screening in San Francisco
The HepB Free Project is hosting a screening on Saturday, Mar. 1 at 2330 Post Street in San Francisco, from 9 am to noon. Interpreters will be available to provide translation in Cantonese, Mandarin, Vietnamese, Korean and Japanese.
The HepB Free Project is housed in the San Francisco Department of Public Health. The program is a citywide effort to eradicate hepatitis B from the City of San Francisco by providing free screening efforts and affordable vaccination. Janet Zola, coordinator, HepB Free Project, approached UCSF’s top leadership to join hands in the HepB eradication effort.
On Feb. 4, the HepB Project partnered with the UCSF National Center of Excellence for Women’s Health and the Asian Heart & Vascular Center to put on a special joint HepB, blood pressure and blood sugar screenings to celebrate the National Heart Awareness Month.
Many patients don’t know they have been infected with Hepatitis B until they are referred to their physicians for other diseases, such as liver cirrhosis or liver cancer.
According to the HepB Free project Asians are at higher risk. “Nearly one in three Asians have been infected by the Hepatitis B virus, and protection from it is necessary to prevent unnecessary death,” said Zola.
Working together at the HepB Project: UCSF (in white) and UCB (in blue) students with faculty Josh Adler, MD, Director of Pathways to Discovery and UCSF HepB Project lead; Francis Yao, MD, Associate Medical Director, Liver Transplantation; and Marion Peters, MD, Chief of Hepatology Research; and staff
By Shipra Shukla
Free screening in San Francisco
The HepB Free Project is hosting a screening on Saturday, Mar. 1 at 2330 Post Street in San Francisco, from 9 am to noon. Interpreters will be available to provide translation in Cantonese, Mandarin, Vietnamese, Korean and Japanese.
The HepB Free Project is housed in the San Francisco Department of Public Health. The program is a citywide effort to eradicate hepatitis B from the City of San Francisco by providing free screening efforts and affordable vaccination. Janet Zola, coordinator, HepB Free Project, approached UCSF’s top leadership to join hands in the HepB eradication effort.
On Feb. 4, the HepB Project partnered with the UCSF National Center of Excellence for Women’s Health and the Asian Heart & Vascular Center to put on a special joint HepB, blood pressure and blood sugar screenings to celebrate the National Heart Awareness Month.
Many patients don’t know they have been infected with Hepatitis B until they are referred to their physicians for other diseases, such as liver cirrhosis or liver cancer.
According to the HepB Free project Asians are at higher risk. “Nearly one in three Asians have been infected by the Hepatitis B virus, and protection from it is necessary to prevent unnecessary death,” said Zola.
Working together at the HepB Project: UCSF (in white) and UCB (in blue) students with faculty Josh Adler, MD, Director of Pathways to Discovery and UCSF HepB Project lead; Francis Yao, MD, Associate Medical Director, Liver Transplantation; and Marion Peters, MD, Chief of Hepatology Research; and staff
Monday, February 25, 2008
UCSF School of Medicine: "Students Help Community Fight Hepatitis B"
By Camille Mojica Rey
02.25.08
Ben Huang knew that hepatitis B was a poorly understood disease in the Asian-American community, but not until the UCSF medical student came face-to-face with an elderly Chinese couple during a clinic at Mt. Zion Hospital did he appreciate the impact those misconceptions were having on families disproportionately affected by the disease. "The husband was a chronic carrier whose wife would not allow him to play with his grandchildren," said Huang, a member of UCSF's San Francisco Hepatitis B collaborative, a student-run organization. The couple had come to the collaborative-sponsored clinic so that the wife could get free screening for the virus. While there, the husband pleaded with Huang to explain to his wife that the virus could not be spread to the family through casual contact. "She wouldn't even let him use the same utensils as the rest of the family," Huang said. "He felt isolated."
The collaborative has proven to be a successful way to expose students to community-based health care while addressing an important health disparity faced by San Francisco's Asian-Pacific Islander (API) community, said Albert Yu, a UCSF clinical professor of family and community medicine who was the group's first faculty sponsor. "We are creating an educational curriculum for introducing students from all health professions to community-based health," said Yu, who is also the medical director at the San Francisco Department of Public Health's Chinatown Public Health Center (CPHC).
The success of the collaborative, which was started by students in 2004, has been recognized nationally. Last year, it received a four-year Caring for Community grant from the Association of American Medical Colleges. In 2006, it received the Paul R. Wright Excellence in Medical Education Award from the American Medical Student Association. The collaborative is a partner in the SF Hep B Free citywide initiative to eradicate hepatitis B.
Students who take part in the collaborative work to create community partnerships that raise public awareness and educate, screen and vaccinate patients against hepatitis B. The collaborative offers free screenings and low-cost vaccination during regular clinics at Mt. Zion and CPHC, as well as at community centers around the city. Members of the collaborative currently screen about 70 patients and administer an average of 30 vaccines on average per month to those who need them. "It's amazing the difference these students have made," Yu said.
Students from UCSF's schools of dentistry, medicine, nursing and pharmacy who take part in the
collaborative are required to sign up for a two-part elective in which they learn the basics of community outreach and hepatitis B education, as well the skills they need to draw blood and administer vaccines.
In addition to the satisfaction of addressing the needs of the community, Huang said first-year students benefit from working with patients so early in their careers. "What we're learning is more than data. We get actual patient contact and we get to educate them about hepatitis B," Huang said.
According to Yu, San Francisco's diverse API community is the city's fastest growing segment of the population and has a real need for the services being offered by the students of the collaborative. He pointed out that hepatitis B occurs at significantly higher prevalence rates in API communities, with as many as one in ten individuals being infected. Without treatment, between 15 and 40 percent of those infected will die from complications, including liver cancer and cirrhosis. APIs make up 50 percent of hepatitis B-related deaths in the U.S.
Alng with Yu, two additional faculty members serve as faculty sponsors: Cindy Lai, assistant clinical professor of medicine, and Joshua Adler, an associate clinical professor of medicine and director of ambulatory practices. First-year students perform clinical procedures, while second-year students are largely responsible for coordinating, publicizing and setting up the clinics. UCSF students have even enlisted help from UC Berkeley undergraduates who serve as interpreters.
The collaborative also hosts a website and has put in place an infrastructure to deal with the inevitable turnover of medical students as they advance in their studies. "The biggest challenge of working with students is transition among leadership," Yu explained. But with second-year students acting as board members and responsibilities divided among committees, the collaborative is able to go beyond screenings and vaccinations. "Our students are now helping to manage the care of those who test positive for hepatitis B infection," Yu said.
Students volunteering with the San Francisco Hepatitis B Collaborative
For Huang, being a part of the collaborative has been a life-changing experience. "I didn't really realize the different kinds of opportunities to serve underserved communities. Now I know I want to be part of something like this in my future career," Huang said. He also said that it has been empowering to see the impact students can have on the health of the community. "I have seen how we as students can be effectiveand make a difference."
02.25.08
Ben Huang knew that hepatitis B was a poorly understood disease in the Asian-American community, but not until the UCSF medical student came face-to-face with an elderly Chinese couple during a clinic at Mt. Zion Hospital did he appreciate the impact those misconceptions were having on families disproportionately affected by the disease. "The husband was a chronic carrier whose wife would not allow him to play with his grandchildren," said Huang, a member of UCSF's San Francisco Hepatitis B collaborative, a student-run organization. The couple had come to the collaborative-sponsored clinic so that the wife could get free screening for the virus. While there, the husband pleaded with Huang to explain to his wife that the virus could not be spread to the family through casual contact. "She wouldn't even let him use the same utensils as the rest of the family," Huang said. "He felt isolated."
The collaborative has proven to be a successful way to expose students to community-based health care while addressing an important health disparity faced by San Francisco's Asian-Pacific Islander (API) community, said Albert Yu, a UCSF clinical professor of family and community medicine who was the group's first faculty sponsor. "We are creating an educational curriculum for introducing students from all health professions to community-based health," said Yu, who is also the medical director at the San Francisco Department of Public Health's Chinatown Public Health Center (CPHC).
The success of the collaborative, which was started by students in 2004, has been recognized nationally. Last year, it received a four-year Caring for Community grant from the Association of American Medical Colleges. In 2006, it received the Paul R. Wright Excellence in Medical Education Award from the American Medical Student Association. The collaborative is a partner in the SF Hep B Free citywide initiative to eradicate hepatitis B.
Students who take part in the collaborative work to create community partnerships that raise public awareness and educate, screen and vaccinate patients against hepatitis B. The collaborative offers free screenings and low-cost vaccination during regular clinics at Mt. Zion and CPHC, as well as at community centers around the city. Members of the collaborative currently screen about 70 patients and administer an average of 30 vaccines on average per month to those who need them. "It's amazing the difference these students have made," Yu said.
Students from UCSF's schools of dentistry, medicine, nursing and pharmacy who take part in the
collaborative are required to sign up for a two-part elective in which they learn the basics of community outreach and hepatitis B education, as well the skills they need to draw blood and administer vaccines.
In addition to the satisfaction of addressing the needs of the community, Huang said first-year students benefit from working with patients so early in their careers. "What we're learning is more than data. We get actual patient contact and we get to educate them about hepatitis B," Huang said.
According to Yu, San Francisco's diverse API community is the city's fastest growing segment of the population and has a real need for the services being offered by the students of the collaborative. He pointed out that hepatitis B occurs at significantly higher prevalence rates in API communities, with as many as one in ten individuals being infected. Without treatment, between 15 and 40 percent of those infected will die from complications, including liver cancer and cirrhosis. APIs make up 50 percent of hepatitis B-related deaths in the U.S.
Alng with Yu, two additional faculty members serve as faculty sponsors: Cindy Lai, assistant clinical professor of medicine, and Joshua Adler, an associate clinical professor of medicine and director of ambulatory practices. First-year students perform clinical procedures, while second-year students are largely responsible for coordinating, publicizing and setting up the clinics. UCSF students have even enlisted help from UC Berkeley undergraduates who serve as interpreters.
The collaborative also hosts a website and has put in place an infrastructure to deal with the inevitable turnover of medical students as they advance in their studies. "The biggest challenge of working with students is transition among leadership," Yu explained. But with second-year students acting as board members and responsibilities divided among committees, the collaborative is able to go beyond screenings and vaccinations. "Our students are now helping to manage the care of those who test positive for hepatitis B infection," Yu said.
Students volunteering with the San Francisco Hepatitis B Collaborative
For Huang, being a part of the collaborative has been a life-changing experience. "I didn't really realize the different kinds of opportunities to serve underserved communities. Now I know I want to be part of something like this in my future career," Huang said. He also said that it has been empowering to see the impact students can have on the health of the community. "I have seen how we as students can be effectiveand make a difference."
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