Stopping a Silent Killer in the Underserved Asian Community: a Novel Liver Cancer Prevention Clinic

Background:
Asian and Pacific Islanders bear a disproportionate burden of liver disease caused by chronic hepatitis B virus (HBV) infection, which is associated with a 25% risk of death from cirrhosis or liver cancer. However, few community based programs exist to tackle this serious public health problem.

Setting:
The Hep B Free Clinic is a student-run grassroots organization that focuses on HBV and liver cancer prevention in one of the nation's largest immigrant communities: San Jose, California.

Population:
Low income, uninsured Asian and Pacific Islander immigrants.

Project Description:
From 2007-2008, we provided free HBV serological screening to 510 patients. For chronically infected patients who elected to undergo follow up monitoring, a series of blood tests were given to evaluate for liver damage (alanine transaminase, ALT), a liver cancer marker (alpha-fetoprotein, AFP), and HBV replication (HBV DNA levels).

Results/Lessons Learned:
Of those screened, 17% were chronically infected. Remarkably, one-third (33%) of infected patients were unaware that they were infected. Of those chronically infected, 100% showed signs of active liver damage as measured by elevated ALT, and 9% had elevated AFP tumor markers for hepatocellular carcinoma. Nearly one-quarter (24%) of those chronically infected carried HBV DNA levels that met the criteria for treatment. Patients who were candidates for antiviral therapy were signed up for free drug assistance programs, and those requiring triphasic CT scans for possible liver cancer were referred. Uninfected patients lacking protective HBV antibodies were provided free vaccinations. Our striking findings call for more aggressive liver cancer prevention in this community, including universal screening for HBV.