People who have come to the United States from Asian countries may have an especially high risk of liver cancer because many are infected with hepatitis B, according to a recent report. Researchers from New York University (NYU) found that 15% of newly tested immigrants in New York City -- or about 1 in 7 -- had chronic (long-term) hepatitis B infections, which can progress into liver cancer in some cases.

The findings were published in a recent issue of Morbidity and Mortality Weekly Report, a publication of the US Centers for Disease Control and Prevention (CDC).

Making people aware of the findings is important, American Cancer Society experts say, because liver cancer takes a severe toll among Asian populations, though it is not as common among other racial and ethnic groups in the US.

"Its incidence rate is No. 4 in Asian males, and in mortality for Asian males, liver cancer is No. 2, right behind lung cancer," said Ming-der Chang, PhD, vice president of Asian Initiatives in the Flushing, New York, office of the American Cancer Society's Eastern Division. "Every one of us in our community knows someone who died of liver cancer."

The American Cancer Society estimates that about 18,510 people in the US will be diagnosed with liver cancer or intrahepatic bile duct cancer in 2006, and 16,200 will die from these conditions.

Hepatitis B is the leading cause of liver cancer worldwide, though that is not the case in the United States. That's at least partly because children born in the US are routinely vaccinated against hepatitis B, which prevents them from becoming infected in the first place.

In many Asian countries, however, vaccinations are not available or not widely used, and many people become infected with hepatitis B during childhood. The virus can be transmitted through blood or sexual contact. Pregnant women can pass the infection to their children at birth, and children may pick up hepatitis B from constant close contact with infected family members.

While most people infected with hepatitis B as adults recover completely within a few months, those infected as children are much more likely have chronic (long-term) infections. These people are at risk of eventually getting complications like cirrhosis and liver cancer.

Although many Asian immigrants are aware that hepatitis B is a problem, few know all they should know to keep themselves healthy, said Henry Pollack, MD, the lead author of the report in MMWR. He is project director and principal investigator of the hepatitis B and hepatocellular carcinoma project at NYU's Center for the Study of Asian American Health.

For instance, few realize that people can be infected with hepatitis B but not have any symptoms of illness, Pollack said. Likewise, many don't know there's a vaccine that can protect people from the virus if they aren't yet infected but have close contact with people who are. And many aren't aware that close monitoring (and possibly treatment) of chronically infected people may help keep the hepatitis from worsening into liver cirrhosis or cancer.

Chronically infected people should be checked for liver cancer a couple of times per year with blood tests and ultrasound, Pollack said. If cancer does develop, this regular testing can find it at an early stage, when it is easier to treat.

Lifestyle changes like not drinking alcohol, stopping smoking, and losing weight can help reduce the risk of hepatitis progressing, he added.

Pollack and his collaborators launched a program to inform Asian immigrants and their families about the issues surrounding hepatitis B, get people screened for the virus, and get them into treatment when needed. They tested more than 1,800 people, of whom 925 had not been tested before. Among those never tested, 137 had a chronic hepatitis B infection. Most of those never tested were born in China or South Korea; only 10 were born in the US, and none of those people had hepatitis B.

But testing for the virus was only part of the program. American Cancer Society staff helped doctors arrange follow-up visits with people who tested positive, and helped those people get further care, if needed, Chang said. ACS staff also helped arrange vaccinations for people who were not infected but at risk.

That patient-navigator approach helped get lots of people the treatment they needed, Pollack said. Follow-up rates for vaccination and treatment were "phenomenally high," around 80%-90%.

Outreach was also important, Chang said, because there is a great deal of confusion about hepatitis B and other forms of hepatitis (such as A and C), and a lot of stigma attached to these infections.

"We have a hard time getting people to come out and say, 'I'm a carrier and I'd like to talk about it,' " said Chang. "It's a shame because it's absolutely preventable, because if you immunize everybody at birth, you can wipe out this disease."

Pollack said anyone who was born in a country with high rates of hepatitis B should get tested for the virus, as should their close family members and partners.

"The only way you can really know if you're infected is by getting tested," he said. "If you're infected, you have to be monitored and evaluated, partly to see whether you might benefit from medication, and also to monitor the risk of liver cancer."

Citation: "Screening for Chronic Hepatitis B Among Asian/Pacific Islander Populations -- New York City, 2005." Published in the May 12, 2006, Morbidity and Mortality Weekly Report (Vol. 55, No. 18: 505-509). First author: Henry Pollack, MD, New York University.