Your Health

Hepatitis B and liver cancer epidemics hit close to home

The Bay Area is the epicenter of a liver cancer epidemic. There are more cases of liver cancer in Santa Clara and San Francisco counties than anywhere in the United States.

Largely caused by hepatitis B viral infection (HBV), liver cancer is lethal. According to the World Health Organization, it kills nearly 750,000 people each year. The five-year survival rate after diagnosis is just 15 percent.

The good news is that most cases of liver cancer can be prevented. There is an effective and safe vaccine for HBV that the Centers for Disease Control and Prevention and WHO call the first “anti-cancer” vaccine. HBV is also easily diagnosed with a simple blood test. The challenge is to educate, test and vaccinate as many people as possible, especially those at greatest risk.

HBV, which can appear in either chronic or acute form, is responsible for 80 percent of liver cancers. HBV is called a “silent killer” because most people with chronic infection often have no symptoms. By the time they realize they have the disease, it is too late for effective treatment. Sometimes people only find out about the disease when they are diagnosed with liver cancer. Untreated, HBV can also lead to cirrhosis and liver failure.

HBV is transmitted much the same way as HIV/AIDS. It is only transmitted through blood or semen, but it is 100 times more infectious than HIV. It cannot be transmitted through casual contact.

No one is immune, but liver cancer is especially prevalent in people from Asia and the Pacific Islands. The statistics are staggering. Asians and Pacific Islanders make up 4.5 percent of the U.S. population but account for more than 50 percent of chronic hepatitis B cases. Recent immigrants are at greater risk. Two-thirds of those infected are unaware that they have HBV. Many acquired the virus at birth from mothers who were unaware they were carriers.

In Santa Clara County, where an estimated one-third of the population is of Asian descent, approximately 35,000 live with chronic HBV. A quarter of those with chronic HBV will die from liver cancer.

The Stanford Asian Liver Center and Stanford Health Library have scheduled “Understanding Hepatitis B and Liver Cancer,” a program featuring Stanford physician Stephanie Chao, M.D., 10 a.m. Nov. 5 at the Clark Center auditorium on the Stanford Medical School campus. Admission is free and open to the public. To register, call 498-7826.

Interested in learning more? Visit Stanford Health Library for books and additional resources, in both English and Chinese.

A good place to begin is “The Liver Disorders and Hepatitis Sourcebook” (McGraw Hill, 2006). Author Howard J. Worman, M.D., professor at Columbia University, covers the broad topic of liver disorders, so there is much more in the book than the focused discussion of HBV and liver cancer.

The value of this book is in Worman’s clear, reader-friendly explanation of liver function and things that can go wrong with the liver. An excellent chapter on viral hepatitis begins with an explanation of viruses in general before he delves into the specific types of hepatitis, including hepatitis B. A similar book is the “Cleveland Clinic Guide to Liver Disorders” (Cleveland Clinic, 2009).

A new book, “Hepatitis Essentials” (Jones & Bartlett, 2011), provides a concise overview of viral hepatitis. It is written for clinicians but is of interest to many consumers. With contributions from some of the world’s leading hepatitis experts, this book covers all aspects of prevention and management of the disease.

An action plan that both describes the problem and prescribes a solution, the National Academy of Sciences Institute of Medicine published a report in 2010, “Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C” (Institute of Medicine for the National Academies of Science). The report makes a strong case for stepped-up vaccination efforts, a public education campaign and increased resources for prevention and treatment, as HBV infection is increasing nationwide. It explains that few among the populations most at risk seek testing or information on how to protect themselves from infection. It is valuable reading for those who want to understand the issues better.

Stanford Health Library has a large collection of books on HBV and liver cancer written in simplified Chinese. The library also carries DVDs.

Stanford Health Library is free and open to the public in five locations: Stanford Shopping Center, Stanford Hospital, Stanford’s Cancer Center, the Taube Koret Center for Jewish Life and the Ravenswood Family Health Center. For more information, call 725-8400, email This email address is being protected from spambots. You need JavaScript enabled to view it. or visit

Nancy Dickenson is head librarian at Stanford Health Library.

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