Sound alarm on health risks

Posted: May 24, 2013

By Helen Ouyang

At age 33, I outlived my father this year. He died when he was only 32. I was 3 years old and my brother was 5.

My father was diagnosed with liver cancer on Halloween. On Thanksgiving Day, my mother was a widow.

He first complained of fatigue in September of that year. Then he noticed his urine was the color of tea. At first, no doctor at our local hospital in New Jersey could pinpoint the diagnosis. But as soon as my grandmother heard his symptoms, she knew he had liver cancer - she had already lost another son to the same disease.

Born in China, my father immigrated to the United States for graduate school, where he met my mother. Campus sweethearts by their first American winter, they harmonized their Old World culture with their new Western lives, searching for the most authentic Chinese noodles, while practicing English colloquiums together.

Though my father's tongue gradually lost its Mandarin accent, he never could shed the hepatitis-B virus he likely acquired as a baby in China. There, almost half of hepatitis-B infections are caused by mother-to-child transmission during birth. His story is not unique - not to the Asian community, anyway.

Hepatitis B is the greatest health disparity between Asian Americans and white Americans. More than 60 percent of Americans living with chronic hepatitis B are Asians or Pacific Islanders, though they comprise less than 5 percent of the total population. Nearly one in 10 people of Asian or Pacific Islander descent is chronically infected.

While almost all healthy adults will clear the virus, 90 percent of infants and 50 percent of young children infected will develop a chronic infection. One in four of them will die - often in the most productive years of life, like my father.

The hepatitis-B virus is 50 to 100 times more infectious than HIV, and 10 times more people worldwide are living with chronic hepatitis B than with HIV. Hepatitis B causes 80 percent of the liver cancer in the world.

Fortunately, an effective hepatitis-B vaccine has been available since 1982. It is the world's first anticancer vaccine.

Unfortunately, only one in five infants worldwide receives a dose at birth. Despite bearing the greatest burden of the disease, China only made the vaccine free in 2005.

As May brings Asian Pacific American Heritage Month, beyond honoring the cultures with food, dance, stories, and parades, we ought to take this opportunity to raise awareness about hepatitis-B prevention and early diagnosis.

Multiple studies show that doctors in the United States - regardless of ethnicity or geographical location - do not routinely screen Asian patients for hepatitis B.

While more non-Asian Americans are infected as adults, more Asian Americans are infected when they are young and progress to liver cancer or failure. They need to be monitored closely.

Doctors may consider offering the vaccine beyond the standardized immunization schedule, as many Asian Americans may not have received the childhood vaccine if they immigrated to the United States.

At the same time, Asian Americans need to be proactive and request testing for hepatitis B, even if their doctors may not raise it. Chronic carriers need to initiate asking for regular screenings for liver cancer.

Asian Americans are often reluctant to see a doctor. My father downplayed his symptoms and waited until he was dying. He probably would've waited even longer, if it were not for the pleading of my mother.

My father's delay in seeing a doctor until he was end-of-life is nearly culturally universal. My Asian colleagues and I intuitively know that when an Asian patient comes into our emergency room, he or she is really sick.

That's why public-health outreach is essential in this community. Programs such as the Jade Ribbon and San Francisco Hep B Free Campaigns, both in California, have been particularly successful. They prove that raising awareness and increasing knowledge among both providers and patients can make a real impact.

I hope that while observing Asian Pacific American Heritage Month, we also use it to look forward. While it was too late for my father, perhaps this May, a doctor will remember to test his Chinese patients for hepatitis B, when he otherwise may not have. Or a mother will ask her child's pediatrician to vaccinate him because he was born in Vietnam.

And maybe someday, Asian American families will not only celebrate their heritage in May, but they will also celebrate it because it helped save a loved one's life.


Helen Ouyang, M.D., is an assistant professor of medicine at Columbia University and a faculty affiliate of the Harvard Humanitarian Initiative. She is the associate director of Columbia's International Emergency Medicine Fellowship Program. E-mail her at houyang@post.harvard.edu.

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