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Stemming an epidemic: Samuel So tackles the causes of liver cancer in Asian-American communities

Photo: Frank Gaglione
Samuel So, MD
  In December 2005, So collaborated with congressmen Michael Honda (D.-Calif.) and Charlie Dent (R.-Pa.) to introduce the National Hepatitis B Act. If enacted, this bill would allocate research funding for this disease.

Liver cancer surgeon Samuel So wants to stop a deadly worldwide epidemic of liver cancer that he's convinced too few people are addressing. And he's perfectly willing to devote a lot of time and attention to public education and prevention, especially if success will keep patients out of his operating room.

As an outgrowth of his research in liver cancer genomics and pioneering techniques of liver resection, So discovered an alarming gap in the public health picture: Although 600,000 persons in the world die each year of primary liver cancer, the problem is relatively rare among non-Asians in the United States.

That statistic has kept liver cancer low on the public-policy radar screen in the United States and has hurt education and research funding, said So, MD, the Lui Hac Minh Professor of Surgery at the School of Medicine.

This is particularly bad news for Asian and Pacific Islander communities in the United States, which suffer from the disease in disproportionately high numbers. For example, liver cancer rates are 13, eight, and six times higher in Vietnamese, Korean and Chinese American males than their Caucasian counterparts.

Significantly, 80 percent of liver cancer within these communities is caused by chronic hepatitis B infection - endemic in Asian nations, where 10 to 20 percent of the population is infected at birth or early childhood. Today nearly 15 percent of Asian Americans are infected with the virus; of these, one in four will eventually die of liver cancer.

This health disparity between Asian and non-Asian communities in the United States is particularly stark in the Bay Area where Asians and Pacific Islanders represent the fastest-growing communities and comprise a third of the population of San Francisco, and 20 percent of San Mateo, Santa Clara and Alameda counties. Because 80 percent of Asians and Pacific Islanders in California are foreign-born, many do not know they are hepatitis B carriers and are not aware of the risk for liver cancer. The combination of these factors has given the Bay Area the highest incidence of liver cancer in the country, So said.

In the face of this crisis, So has undertaken an outreach effort with a sense of missionary zeal. In 1996 he founded the Asian Liver Center at Stanford, the only nonprofit organization in the United States dedicated to addressing the disproportionately high incidence of hepatitis B and liver cancer among Asians and Asian Americans.

One goal of this effort is to give his colleagues in family practice a simple take-home message. "Test all of your API [Asian and Pacific Islander] patients for hepatitis B. A one-time, simple and cheap screening blood test will stop a cycle of illness and death that systematically falls under the radar screen in this country," said So.

In 2001 So helped launch a public education program within the Asian Liver Center called the Jade Ribbon Campaign. The program brings together 400 community organizations to educate local Asian and Pacific Islander American populations about the risks they face.

So’s efforts extend to the national and international arenas, as well. In December 2005, he collaborated with congressmen Michael Honda (D.-Calif.) and Charlie Dent (R.-Pa.) to introduce the National Hepatitis B Act. If enacted, this bill would allocate research funding for this disease. The bill is currently under review by the House Committee on Energy and Commerce.

So also travels extensively to reinvigorate prevention programs and raise awareness in China, the Philippines and other Asian nations, where liver cancer takes more lives than heart disease.

“Even though we have had a very safe and effective vaccine (for Hepatitis B) for more than 20 years, we are not implementing an effective screening and vaccination program worldwide to eliminate this infection,” said So. “Hepatitis B brings up one of the vexing issues we have in modern medicine: the giant gap between what we have discovered and what we have implemented.”

So's efforts are, however, starting to make a difference. Working with the California Department of Health, the American Cancer Society and others, So was instrumental in crafting the first liver cancer prevention plan for the state of California that calls for all Asians and Pacific Islanders to be tested and vaccinated against hepatitis B by 2010.

Beyond liver cancer prevention, his efforts are helping to improve patient outcomes for those diagnosed with the disease. According to So, who is the director of Stanford's Liver Cancer Clinic and Tumor Board, the key to effective care is a multidisciplinary approach to treatment.

"I pushed hard to start the liver cancer tumor board when I got tired of hearing discussions that could degenerate into a feeling of 'You shouldn't have done that, you should have…,'" said So. "I wanted to develop and join a team of internists, surgeons, cancer specialists, as well as diagnostic and interventional radiologists, who would look for the best alternative for the individual patient right from the start."

-Courtesy of Medical Update

Posted: 12/21/06

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