Current liver cancer screenings may leave African Americans at greater risk

Early detection could reduce the number of African Americans dying from liver cancer, but current screening guidelines may not find cancer soon enough in this community, according to a study published in Cancer in February.

Black patients with liver cancer often have a worse prognosis than those of other racial and ethnic groups. Mount Sinai researchers sought to understand the reasons for this disparity by studying patients with hepatitis C, the leading driver of liver cancer in the United States.

Hepatitis C virus infection can result in cirrhosis, which greatly increases the risk of liver cancer. Because of that risk, current guidelines emphasize the need for screening among patients who have already developed cirrhosis.

However, the rate of liver damage is slower among Black patients, and this study shows that the risk of liver cancer in Black patients with hepatitis C may begin earlier in the course of their liver disease, often before the onset of cirrhosis. Mount Sinai researchers found that nearly one-third of Black patients in their study would not have qualified for liver cancer screening using common cirrhosis measures.

In addition, the study found that at the time of diagnosis, the tumors in Black patients tended to be larger, more numerous, more aggressive, and more invasive.

"We know that disparities in outcome exist for Black patients with liver cancer. The reasons for this are complex and multifactorial, and this study points to two likely contributing factors," said lead author Umut Sarpel, MD, Associate Professor of Surgery, and Medical Education at the Icahn School of Medicine at Mount Sinai. "First, they may fall outside screening guidelines, thus delaying diagnosis. Second, the biology of their tumors may be inherently more aggressive. We suggest additional studies to see if modified guidelines can better serve this community and to determine if the tumors have a distinctive molecular signature that may allow targeted therapies to be deployed."

This research studied the imaging, laboratory, and pathological findings of 1,195 patients with liver cancer who had a history of hepatitis C exposure, 390 of whom identified as African American. It was a larger and more detailed investigation of findings first reported by co-author Andrea D. Branch, Ph.D., Professor of Medicine and the Director of Basic and Translational Research in the Mount Sinai Institute for Liver Medicine.