Mayo study links hepatitis C to liver cancer

Mayo study links hepatitis C to liver cancer
by Rupa Shenoy, Minnesota Public Radio
January 3, 2012

St. Paul, Minn. — The Mayo Clinic released a study today that identifies hepatitis C as a cause of rising liver cancer rates. Researchers say with that information, more people can be screened for hepatitis C and prevent cancer.

The finding may have a particular impact on the Somali community. That's because a second study published by Mayo today says hepatitis C rates among Somalis are much higher than previously suspected.

The first study from the Mayo Clinic confirms that scarring from hepatitis C can develop over decades into liver cancer. The study used a database of medical records for everyone who's had inpatient or outpatient care in Olmsted County. The database includes comprehensive information about each patient, making it possible for researchers to find patterns that weren't apparent before.

The study, while in progress, caught the attention of Mayo researcher Abdirashid Shire, who visits most of the Somali patients at Mayo and is Somali himself. He's seen many friends die of advanced liver cancer. So Shire led a second study by digging into the Mayo database, picking out the Somali names, and looking for patterns.

"When we looked at those who develop liver cancer, during the timeframe we looked at between 1996 and 2001, we found 30 people who developed liver cancer," said Shire. "And can you imagine -- almost 80 percent, the liver cancer was due to hepatitis C."
Until now, Shire says the medical community only knew of one strain of the hepatitis virus prevalent among sub-Saharan Africans -- hepatitis B. Currently, Somali refugees coming to the US aren't even regularly screened for hepatitis C. Shire says if they were, doctors could catch liver problems before they progress past the point of treatment.

There are few early signs of hepatitis C. The virus is transferred through sex or blood transfusions -- and it can run rampant in places like Somalia or African refugee camps, where physicians may not always sterilize needles thoroughly between patients.
Shire says people often don't know they have hepatitis C until decades after the initial infection. By that time, it can be too late.

Amina Arele, 66, sits in a hospital room with tubes running from her nose and IVs taped to her left forearm. Arele got a liver transplant three days earlier. She was diagnosed with liver cancer this summer, although she had always been healthy to that point. Arele likely would have died without the liver transplant, since only about one in 10 people diagnosed with advanced liver cancer survives.

Arele says her husband had hepatitis C when they lived in Somalia 30 years ago. She is not sure when she contracted the disease from him, but believes it was just recently.
Arele's son, Rashad Hassan, says this has been a wakeup call for his family.
"One of the things that ... the family members decided to do is make sure we have hepatitis C testing," said Hassan.

Arele's transplant doctor, Mohammad Hassan, says that family approach is important.
"There's a lot of extended family decisions involved here," said Hassan. "You have to talk with the cousin, you have to talk with the uncle, you have to talk with the wife, you have to talk with the children, if they are old enough."
Hassan says Somalis tend to make decisions as a community, so education on this issue is a big job.

Hassan and researcher Abdirashid Shire are just starting that effort, by speaking to community groups and on Somali TV. They know there's no time to lose -- Shire lost a good friend to liver cancer just a few weeks ago.

Abdullahi Abdi Hassan was a small businesses owner in Eden Prairie. His sister, Ayan Hassan, says he brought 24 family members to this country and paid to educate each one. Ayan Hassan, who's a nurse, says her brother got hepatitis C through a blood transfusion in Somalia.
"It really upset me when I find out his doctor was not doing ultrasound, because people who have hepatitis should get blood drawn every year and they should be getting ultrasound every six months," she said.

Abdullahi Hassan was diagnosed with liver cancer this fall. Surgery didn't help. He was in the hospital for three weeks before he died.

Ayan Hassan says dozens of Somalis came to see her brother every day, and he told all of them to make an appointment to get tested with his friend, Mayo researcher Abdirashid Shire.

http://minnesota.publicradio.org/display/web/2012/01/03/liver-cancer-somalis-hepatitis/