Asian community takes aim at hepatitis B
San Francisco public health officials and Asian community leaders are trying to eradicate hepatitis B from the city - a tall order, considering the city has the highest concentration of hepatitis B in the country, as well as the highest rates of liver cancer, which is usually caused by the virus.
The key to wiping out hepatitis B - and protecting people from liver cancer - is to make screening a basic part of health care, especially among Asians, say doctors and Asian American health advocates who have launched a campaign to get more people tested.
"We have the potential to wipe this disease off the face of the Earth," said Ted Fang, publisher of AsianWeek, an online news service, who helped create a local campaign called San Francisco Hep B Free. "We're trying to make hepatitis B prevention and screening a standard of care for Asian Americans."
As many as 1 in 10 Asian Americans is infected with hepatitis B, which is usually a benign virus that causes no symptoms. But among those with chronic infections, meaning they carry the virus throughout their lives, 25 percent will develop serious complications that can lead to liver cancer and death. The rate of survival beyond five years for liver cancer is about 26 percent if it doesn't spread outside the liver.
Hepatitis B is widespread in many Asian countries, especially China, and San Francisco has unusually high rates of hepatitis B and liver cancer because of its large Asian population. It's impossible to get accurate infection rates. But hepatitis B is the primary cause of liver cancer, and San Francisco has about 14 cases of liver cancer per 100,000 residents every year, compared with 9.5 cases per 100,000 people nationwide, according to the U.S. Centers for Disease Control and Prevention.
Testing is rare
It's the rate of liver cancer in San Francisco that experts are relying on to determine that the city also has the highest concentration of hepatitis B. Most people aren't tested for hepatitis B, in part because it isn't symptomatic.
Hepatitis B is typically passed like many other viruses - by direct, close contact with an infected individual. It is fairly uncommon in the United States, infecting only about 1 in 1,000 people. For years it was associated with intravenous drug users or people who had unprotected sex with multiple partners. Now most cases are found in immigrants from regions where hepatitis B is widespread.
A vaccine is effective at preventing infection, but few people in China and other countries where hepatitis B is prevalent have been vaccinated. And most people are infected very young - often at birth, when they are exposed to the virus from their mothers. Children who get hepatitis B are more likely than adults to develop chronic infections later in life.
State Assemblywoman Fiona Ma acquired hepatitis B from her mother, who also got the virus from her mother. Ma said she only learned that she carried the virus when she attended a blood drive and was told she couldn't donate. Ma's mother told her not to worry - that she was only a carrier, and the virus posed no health risk.
Two decades later, Ma learned that that wasn't the case when she attended a news conference and a doctor there told her there was no such thing as a safe carrier. Ma started getting regular liver screenings, and so did her mother.
"Last summer, my mother developed some abnormal liver scans, and they had to go in and remove part of her left liver lobe, but because we caught it early and she was monitoring, she's fine," Ma said. "If we hadn't been monitoring, maybe in two years she would have died."
Need to educate
And therein lies the problem, health care providers say. Many people who have hepatitis B either don't know they're infected or believe that it's a harmless virus. Even doctors sometimes will tell patients that hepatitis B isn't something to worry about.
In fact, hepatitis B can become serious and attack the liver if left untreated. Up to 80 percent of all cases of liver cancer in the world are caused by hepatitis B, according to the World Health Organization.
The irony is that hepatitis B is treatable, and liver cancer can be prevented - if patients and doctors know to look for it, said Dr. Samuel So, director of the Asian Liver Center at Stanford University.
"This is a horrible disease that can lead to major complications, but it's also a disease for which we have all the solutions," So said. "We have a vaccine, we have good antiviral drugs, we can screen for cancer. People are dying from preventable deaths."
He, along with a key group of Asian American community leaders and public health officials, helped create San Francisco Hep B Free to raise awareness and work with health care providers to make screening a standard of care for Asian Americans. They're starting with marketing campaigns that encourage Asians and Pacific Islanders to get screened.
Part of the reason it's taken so long to draw attention to hepatitis B - even in San Francisco - is that there is a stigma associated with the virus in China, Ma said, and many Asians are reluctant to talk about the disease.
"Asians do not like to talk about their problems publicly. If you don't have folks willing to be the poster child or talk about the disease or what's happened in their family, we're never going to raise awareness," she said. "But that sentiment is changing. Unless we talk about it, we can't cure it or eradicate it."
The program: More at www.sfhepbfree.org.