Liver Cancer in Hispanic and Latino Communities

The liver is a large organ that has many jobs in the body. It plays a role in digestion. It also filters blood to remove harmful substances.

Liver cancer is cancer that starts in any part of the liver. The most common form of liver cancer is HCC. This type of cancer starts in the cells that make up the body of the liver. Cancer can also start in the ducts of the liver, but this is less common. Rates of HCC continue to rise in the United States.

In 2020, 4.7 percent of new cancer diagnoses in the world were liver cancer. It accounted for 8.3 percent of cancer deaths. In the United States, it’s estimated that there will be about 41,260 people diagnosed with liver cancer in 2022. It’s expected to increase.

Cirrhosis is a major risk factor for developing liver cancer. About 80 percent of people with liver cancer have cirrhosis.

Anything that damages the liver can increase the risk of cirrhosis and liver cancer. Every time there’s damage to the liver, it tries to repair itself. Over time, the damage and repair cycle causes scar tissue.

Cirrhosis is severe scarring of the liver. When there’s too much damage and scar tissue builds up, the liver no longer works properly.

Risk factors for cirrhosis and liver cancer include:

• hepatitis B or C infection
• high alcohol intake
• exposure to aflatoxin from contaminated food, water, or soil
• smoking tobacco
• nonalcoholic steatohepatitis (NASH)

Hispanic people have much higher rates of liver cancer than non-Hispanic white people in the United States. Data from 2014 to 2019 shows they have double the rates of non-Hispanics. Data from 2018 shows that 1 in 5 people with liver cancer in the United States is Hispanic.

Although rates of liver cancer are on the rise in all groups, it’s much higher for Hispanics. This group has seen a 4.7 percent increase per year since 2000.

Hispanic people are also diagnosed at more advanced stages of liver cancer. This means there are often fewer treatment options available. Compared with non-Hispanic white people, Hispanic people have lower rates of liver transplants. One theory to explain the lower rate of transplants is lower rates of health insurance.

There are differences in liver cancer survival in Black, Hispanic, and white people. A study from 2019 found the median survival time was highest for white people at 16.3 months. The median survival time was lowest for Black people at 10.6 months. Survival time for Hispanic people was 14.4 months.

There are a number of factors that may contribute to higher rates of liver cancer in Hispanic and Latino populations.

Hepatitis C

Hepatitis C infection is still a major cause of liver cancer. In Florida, hepatitis C is the primary cause of liver cancer cases among Hispanic people. In the United States, 50 to 60 percent of people with liver cancer live with hepatitis C infection.

Overall, hepatitis C infections are stable or going down. The exception is that, from 2014 to 2018, there was a rise of 2 percent in Hispanic women.

Hepatitis C is a treatable condition. For many people, however, there are major barriers to accessing testing and treatment. Treatment is expensive, and many people don’t know they have it until the advanced stage.

Chronic hepatitis C infection can lead to cirrhosis and sometimes liver cancer. Without regular access to healthcare, hepatitis C may not be detected and treated.

Nonalcoholic fatty liver disease

Another risk factor for liver cancer is non-alcoholic fatty liver disease (NAFLD). NAFLD can progress to another condition called non-alcoholic steatohepatitis (NASH). NASH is an advanced stage of fatty liver disease. Fat builds up around the liver, causing inflammation and scarring.

NAFLD is on the rise, affecting around 75 to 100 million people in the United States.

Hispanics have the highest rates of NAFLD compared to other ethnic groups. Various studies have shown that between 8.4 percent and 45 percent of Hispanic people have NAFLD. They’re also more likely to progress to NASH, increasing the risk of cirrhosis and liver cancer.

A condition called metabolic syndrome is also associated with NAFLD. Metabolic syndrome is a cluster of conditions. It can include high blood pressure, diabetes or prediabetes, and low levels of HDL, or good, cholesterol levels. In the United States, Hispanics have the highest rates of metabolic syndrome.

Cirrhosis

Liver cirrhosis is associated with 80 percent of liver cancer cases. There are different causes of cirrhosis. These include:

• high alcohol intake
• NASH
• hepatitis C infection

Hispanics have higher rates of cirrhosis compared to other groups. A large study showed Hispanics had a 37 percent greater risk of cirrhosis compared to Caucasians. Hispanics are more likely to have cirrhosis related to alcohol intake or NASH.

Liver cancer is not usually diagnosed in the early stages. Symptoms often don’t show up until advanced stages, when it’s harder to treat. In later stages, there are larger and more tumors, or cancer has spread to other parts of the body.

When liver cancer is caught early, there are more treatment options. That’s why regular checkups and routine screenings are important, especially for people at high risk of developing liver cancer.

Access to the right care is needed to prevent and manage risk factors for liver cancer. However, research shows that Hispanics are less likely to access preventative care.

A number of factors may prevent Hispanic and Latino people living with liver cancer from receiving proper care and treatment. These may include:

• socioeconomic status
• lack of health insurance
• language barriers
• lack of access to culturally appropriate care

People living in poverty have a much harder time getting the healthcare they need. In the United States, 16 percent of Hispanics lived in poverty in 2019, compared with 7 percent of non-Hispanic white people.

Hispanic people are also most likely to be uninsured. Among those 18 to 64 years of age, 26 percent lack health insurance. About 9 percent of non-Hispanic white people are uninsured.

The Affordable Care Act helped to improve access for many people. It decreased the number of uninsured Hispanic people by 11.9 percent. Medicaid is run by each state, so there are differences in criteria and access.

In the past decade, several states expanded their Medicaid programs. Other states did not, including Florida and Texas, which have high Hispanic populations. This leaves even more people without access to health insurance.

The cost of medication is another problem in the United States. A large survey of Hispanic people showed that 12.5 percent were unable to pay for prescription drugs.

Lack of access to culturally competent care is also a potential barrier to liver cancer care for Hispanic and Latino people. Cultural competence means healthcare professionals can deliver care that meets the social, cultural, and linguistic needs of their patients.

Hispanic and Latino people come from many countries. They have different traditions, foods, and languages. The care and recommendations for people of one race or background will not work for everyone. Too often, people are given recommendations that don’t fit with their traditions.

Many things need to improve so Hispanic and Latino people have better access to healthcare. Access to culturally appropriate care can improve screening and preventive care. This may help reduce risk factors associated with cirrhosis and liver cancer.

In areas of high Hispanic or Latino populations, better access to health insurance coverage could reduce barriers to receiving care to help prevent and treat cancer.

To address the language barriers, using interpreter services would help. Another huge gap in care is the lack of Hispanic and Latino healthcare professionals. Hispanic and Latino people make up about 5 percent of doctors in the United States.

This is much lower than the 17.4 percent of people in the United States who identify as Hispanic or Latino. We need ways to support more Hispanic and Latino people to get into careers in the medical field. Getting care from someone who speaks your language and understands your culture can make a big difference.

Hispanic and Latino people have higher rates of liver cancer and deaths from liver cancer. There are several possible reasons for this. Hispanic and Latino people have higher rates of metabolic syndrome, NAFLD, and NASH. These increase the risk of cirrhosis and liver cancer.

Hepatitis C is a treatable condition that increases the risk of liver cancer. Hispanic and Latino people are not always able to access the right care or get treatment for hepatitis C.

Language barriers, poverty, and lack of health insurance can prevent access to healthcare.

Increasing culturally competent care and breaking down cost and language barriers can help. With strategies to improve access to care, many cases of liver cancer can be prevented or treated.