Hepatitis is an inflammation of the liver that can be caused by drug or alcohol use, but globally is most commonly caused by a viral infection. Eighty percent of liver cancer in the world is due to one of these and they’re major contributors to the 45 percent jump in liver cancer in the U.S. between 2000 and 2016. Although more than 4 million Americans are estimated to be living with Hepatitis B or Hepatitis C, up to half don’t know it because the diseases can progress years without symptoms and Hepatitis screenings aren’t yet standard practice in primary care. If not diagnosed and treated, this often-overlooked disease can lead to liver cancer.
The Facts
Viral Hepatitis is one of the most common blood-borne diseases in the world and the leading cause of liver cancer. Dr. Wang estimates that Hepatitis B affects 257 million people worldwide and Hepatitis C affects 72 million people worldwide.
“HIV affects around 35 million people worldwide,” said Dr. Wang. “Viral hepatitis is 10 times more common than HIV, but people are not as aware of it. In fact, Hepatitis is endemic in some parts of the world.”
Warning Signs and Long-Term Effects
“Generally chronic Hepatitis B and C are not symptomatic,” said Dr. Wang. “However, you can have acute Hepatitis or a flare up that presents conditional symptoms.”
Although uncommon, these symptoms can include jaundice, nausea, vomiting, fatigue, abdominal distention and general flu-like symptoms.
“The long-term effects of Hepatitis B and C are scarring of the liver, which leads to cirrhosis,” said Dr. Wang. “When your liver is not making the necessary proteins it needs, it affects your clotting abilities and eventually an individual could need a liver transplant or develop liver cancer.”
This is how Dr. Wang and other experts can identify cases of Hepatitis B and C that are going unaddressed.
The Differences between Hepatitis B and C
“The differences in Hepatitis B and C are in how the immune system reacts,” said Dr. Wang.
With Hepatitis B, the immune system is affected, which means we have a vaccine for Hepatitis B. For Hepatitis C, there is no vaccine, but there is a cure, so it can be eradicated.
“The cure for Hepatitis C is 8-12 weeks of oral therapy,” said Dr. Wang. “They are just pills you take and it’s become quite simplified from what it used to be – weekly injections over the course of a year. This is a game changer because if people can be screened, diagnosed and treated, we can eradicate Hepatitis C altogether.”
Hepatitis B doesn’t have a cure yet, but Dr. Wang is confident that collectively we can end the transmission of Hepatitis B if everyone gets vaccinated.
“Liver cancer is on the rise and at this point, death from viral Hepatitis has surpassed deaths due to HIV, malaria and TB. But there are great treatments to control the virus currently and we are seeing curative therapies in the pipeline,” said Dr. Wang.
Common Misconceptions
Hepatitis B and C often get confused with Hepatitis A. Hepatitis A is transmitted by the fecal-oral route. This means that someone who has handled the food you eat, whether it be a restaurant worker or a farmer, had contaminated hands.
“Oftentimes this gets confused with Hepatitis B/C and people think you can’t share food with someone with Hepatitis B or C,” explained Dr. Wang. “This isn’t the case. Hepatitis B and C can only be transmitted by blood.”
Screening and Patient Prevention & Education
The good news is screening for Hepatitis B and C is simple.
“The screening for Hepatitis B and C is a blood test that can be done in conjunction with another routine blood test your regular doctor is already doing,” said Dr. Wang. “You can also always ask your doctor for a Hepatitis test in case they are not otherwise ordering them for you.”
According to the Centers for Disease Control and Prevention (CDC), Asian Americans and Pacific Islander make up less than 5% of the total population in the United States, but account for more than 50% of nearly one million Americans living with chronic Hepatitis. Dr. Wang explains some of the reasons for this health care disparity.
“There are health care access issues which come with language barriers,” said Dr. Wang. “Another issue is awareness amongst the community and providers who might not know to test their patients.”
Dr. Wang also notes that the cultural differences in health care in Asia might offer another explanation for the rates of viral Hepatitis in Asian populations. She explains that in Asian cultures, people might only visit the doctor when they’re sick, not to get regular screenings.
“This is part of the reason that we need to increase general awareness,” said Dr. Wang. “As I mentioned, there are vaccines for Hepatitis B, and Hepatitis C can be treated before someone’s health really starts to suffer.”
Language can also be a big obstacle, but Saint Barnabas Medical Center (SBMC) provides a solution to that barrier.
“Here at Saint Barnabas Medical Center we offer comprehensive primary care services at the Center for Asian Health,” said Dr. Wang. “We have bilingual staff available for those who speak Mandarin, Cantonese and Korean. We also provide individualized navigation to help our patients get the services they need.”
Together SBMC and the Center for Asian Health are working to raise awareness of the importance of health and wellness among Asian populations as well as understanding and testing for Hepatitis. In fact, in 2014 SBMC received a grant from the CDC and began providing community screenings.
“We’ve screened over 2,000 people in the community so far,” said Dr. Wang. “We go out to the people in their communities- we visit to churches, schools, health fairs, weekend events and more. And we continue to provide free screenings through one of our labs at the Ambulatory Care Center.”
Even so, Dr. Wang and the experts at SBMC have found that they need to be more innovative to reach more people to screen for viral Hepatitis.
“Data from the SBMC Cancer Center shows us that for our area, a higher percentage of patients are showing up with stage 4 (end stage) liver cancer,” said Dr. Wang. “That was a call to action for us to be more aggressive. As a result, we’ve been providing screenings for Hepatitis B and C in our emergency room now. The ED volume is high and those who visit the ED might not be visiting their doctors regularly so we’re reaching an entirely new patient population.”
In the first year of the ED screening program 20,000 people were screened and 250 infected people were identified and provided the proper care.
“We are in the era of viral Hepatitis elimination,” said Dr. Wang. “We have the tools to do it.”
For more information on Hepatitis or the Center for Asian Health click here or call 973-261-9080. If you are interested in attending one of the community education events held at the Barnabas Health Ambulatory Care Center in Livingston, New Jersey, you can register for free by calling 215-489-4900.