The Silent Epidemic

Dr. Sam So is the founder of the Asian Liver Center at Stanford University.

Dr. Sam So is the founder of the Asian Liver Center at Stanford University.

By Joel P. Engardio

Liver cancer kills more people in the Bay Area than anywhere in the country, according to the Centers for Disease Control and Prevention -- and by a wide margin.

Why? Because more Asian Americans live here. The connection? The hepatitis B virus. The Asian Liver Center at Stanford University estimates that 10 percent of Asian Americans have hepatitis B and don't know it. Of those, a quarter will die from liver cancer or failure; A staggering number, since the Bay Area is home to 1.3 million Asian Americans.

If these ominous statistics are true, we're facing the biggest health crisis to hit the region since AIDS. That epidemic took 19,000 lives in San Francisco in its first 20 years, as counted by the San Francisco Department of Public Health. But liver cancer or failure will kill 32,000 Bay Area Asian Americans in much less time.

So why haven't you heard about it? Why isn't this a top priority for San Francisco's health officials, politicians, community activists and media? You'd think something that threatens more than one-third of the city's population would warrant some serious inquiries, votes, rallies and front-page coverage.

Few are talking about hepatitis B in Asian Americans, however, because this is a silent epidemic. Silent because there are no symptoms until the cancer takes hold. Silent because most doctors -- using a Caucasian model for diagnosis and treatment -- fail to recognize this unique health risk among their Asian patients. And silent because an uninformed Asian community hasn't demanded better care.

Consider what happened to my partner, Mark Lim: Born and raised in suburban Chicago. Went to one of the best medical schools in the country. Became a doctor in the Bay Area. Died from liver cancer at age 31. If a Chinese American doctor in a largely Asian city can have hepatitis B and not get the tests or treatment that could have saved his life, where does that leave the other 250,000 Asian Americans in San Francisco?

The hepatitis B virus is rampant in Asia, and a large percentage of mothers pass it on to their children at birth. The virus infects males and females equally, but kills more often in men. Children grow up healthy because the dormant virus hides in the liver. But it unleashes its destructive power in young adulthood without warning, which is why Asian men in their 20s and 30s are at such high risk for liver cancer. Being born in the United States versus Asia doesn't matter. Hospitals here didn't even begin screening pregnant women for hepatitis B until the mid-1980s. So an entire generation of kids born in the United States to Asian mothers in the 1970s and 1980s are at risk for liver cancer now.

As a doctor -- and a victim -- Mark felt it was his duty to speak up about what has become the greatest health disparity between Asians and Caucasians. He was moved not only to fight the disease that was killing him, but to wipe out the ignorance that had allowed the problem to get so out of hand.

That's why he became a spokesman for the Jade Ribbon Campaign at Stanford University's Asian Liver Center. A small group dedicated to fighting this silent epidemic, Jade Ribbon is just one voice trying to sound the alarm of a health crisis to come. It was Mark's hope that his medical colleagues and his Asian community would equally rise to the occasion -- giving the politicians and the media reason to follow.

Had Mark learned in his medical training that Asians are at increased risk for chronic hepatitis B and liver cancer because they are typically infected as children, he would have gotten the specific blood tests and ultrasounds to catch the cancer that killed him. And he would have offered the same treatment to his many Asian patients. At the very least, he would have urged them to find out if they are among the 10 percent of Asian Americans who unknowingly have hepatitis B -- because with better education, prevention and treatment, carrying the virus doesn't have to be a death sentence.

Mark was dedicated to saving lives as a doctor. He can't do that anymore, but his story can. If only people will listen.

Also published in San Francisco Chronicle January 3, 2003


Joel Engardio's essay "The Silent Epidemic" was broadcast on KQED-San Francisco January 9, 2003.

Health, SpeechesJoel Engardio