My friend’s dad was one of them. The virus lived inside his body for years, slowly and stealthily damaging his liver until it caused cancer. By the time he was diagnosed, the liver cancer was at an advanced stage, and he died in less than a year. If his doctor had tested him for hepatitis B earlier, his death could have been prevented. After my friend’s dad died, his entire family got tested, and two of my friend’s uncles were found to have chronic hepatitis B. They take daily antiviral medication and undergo regular monitoring for liver cancer, and they’re alive and well today. With testing and treatment, people with hepatitis B can lead full lives.
On March 10, the Centers for Disease Control and Prevention released new guidelines recommending testing all adults for hepatitis B at least once. If detected early, chronic hepatitis B can be treated with antiviral medications that suppress the virus, greatly reducing the risk of liver cancer. The new CDC recommendation has the potential to save many lives. But more action is needed to realize this potential.
Hepatitis B disproportionately affects Asian American communities — 1 in 12 Asian Americans is chronically infected with hepatitis B, compared to 1 in 1,000 non-Hispanic white people. In Asian American communities, barriers that prevent people from undergoing testing and treatment include a lack of knowledge about hepatitis B, and cultural and linguistic barriers.
I’m a Chinese American physician, and I have a relative with chronic hepatitis B who doesn’t follow her doctor’s advice to take antiviral medication and undergo regular monitoring for liver cancer. There are many reasons for her noncompliance. English is not her first language, so it’s hard for her to communicate with doctors. She also feels shame due to the stigma surrounding hepatitis B and holds fatalistic beliefs that inhibit her from taking action. Such beliefs are common among the population — in one survey of Asian Americans, 39% of respondents didn’t think they could do anything to prevent cancer, and 35% didn’t think cancer is curable. Respondents with these fatalistic beliefs were more likely to not get screened for hepatitis B.
In Asian American communities, individuals can take action to encourage more people to undergo screening. In one study of Asian Americans, participants were more than three times as likely to get tested for hepatitis B if a friend recommended they do so and more than five times as likely to get tested if a family member recommends it. Thus, anyone can make a significant difference by talking with loved ones about getting screened.
Community organizations can hold outreach events and conduct media campaigns to promote testing, as does San Francisco Hep B Free. To help reduce stigma, Hep B Free produces videos, ads and events featuring prominent Asian Americans, such as California State Treasurer Fiona Ma, sharing their personal stories of living with hepatitis B. To help dispel fatalistic notions, Hep B Free provides factual medical information emphasizing the benefits of antiviral medication and regular monitoring for liver cancer.
Community organizations can also collaborate with medical institutions to offer screening through health fairs, mobile clinics and standalone testing sites. This would make testing more accessible for people who don’t have transportation, insurance or a primary care doctor. People who distrust the medical system might be more likely to get screened at sites endorsed by trusted community organizations.
Medical institutions can also remind patients and doctors about hepatitis B screening through online portals, text messages and emails. At many medical centers, doctors receive an alert through the electronic medical record if a patient is due for preventive screenings like mammograms; it would not be hard to add another alert for hepatitis B testing.
As a doctor, I know that physicians are often unaware of the latest CDC guidelines and many lack comprehensive knowledge about hepatitis B. Thus, individuals need to be proactive and ask their doctor to test them. Medical institutions should educate physicians about the new CDC recommendation.
When I was in medical school, we learned about the science of hepatitis B, but we didn’t learn about its disproportionate impact on Asian Americans. Teaching medical students and doctors about this racial health disparity — and the cultural and systemic factors contributing to it — would help physicians better serve their Asian American patients.
Mimi Zheng is a Chinese American physician in Los Angeles.
2023-03-29 00:08:46
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