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Latinos have the second-highest rate of dying from liver cancer among racial/ethnic groups.
Understanding the reasons why this is happening can reveal how to address this suffering and prevent liver cancer among Latinos, which can improve health for the broader population.
“Understanding the causes of Latino liver cancer rates in South Texas and across the nation is critical. We must develop interventions and identify high-risk individuals who may be screened and treated with the best available care,” said Dr. Amelie G. Ramirez, leader of Salud America! and the Institute for Health Promotion Research at UT Health San Antonio.
So, why does liver cancer hurt Latinos in particular?
1. Aflatoxin Exposure
Aflatoxins are a family of toxins produced by certain fungi that are found on agricultural crops such as maize (corn), peanuts, cottonseed, and tree nuts.
People can be exposed to aflatoxins by eating contaminated plant products, like peanuts. Or people eat meat or dairy products from animals that ate contaminated feed.
“Farmers and other agricultural workers may be exposed by inhaling dust generated during the handling and processing of contaminated crops and feeds,” according to The National Cancer Institute.
This ultimately impacts Latinos, who make up a large portion of farm and agricultural workers in the United States.
“Many hired farmworkers are foreign-born people from Mexico and countries in Central America, with many lacking authorization to work legally in the United States,” according to the USDA Economic Research Service.
In a 2017 study led by Dr. Ramirez, researchers gauged aflatoxin exposure in 42 liver cancer cases and 42 non-cases from clinics in San Antonio, Texas. Two-thirds of the pairs were Latinos.
Liver cancer cases had six-times-higher odds of having detectable levels of aflatoxins in their blood than non-cases.
“This study means that Latinos have unique exposures that put them at higher risk for liver cancer,” said Dr. Amelie G. Ramirez, study leader and director of Salud America! at UT Health San Antonio.
2. Chronic HBV
HBV, or hepatis B virus, is a vaccine-preventable liver infection that spreads when blood, semen, or other body fluids from a person infected with the virus enters the body of someone who is not infected.
Chronic or long-term HBV can develop into a more serious disease resulting in long-term health problems, including liver damage, liver failure, liver cancer, and even death.
The HBV vaccine is safe and effective and is the best way to prevent the virus.
However, “Black, white and Latino people with chronic hepatitis B are less likely than Asians to be adequately evaluated, and Latinos are less likely to receive treatment,” according to a 2023 study, hepmag reports. “Additional efforts are needed to improve chronic hepatitis B management, especially for non-Asian patients.”
Visit the CDC’s guidelines and prevention recommendations to learn more.
3. Chronic HCV
HCV, or hepatitis C virus, is a viral infection that causes liver swelling (inflammation) that can lead to serious liver damage.
HCV spreads through contact with blood that has the virus in it.
Despite having lower case rates of hepatitis C, Latinos were 40% more likely to die from it than non-Hispanic whites in 2018, according to the Office of Minority Health.
While there is no vaccine for HCV, it can be prevented.
“The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injecting drugs. Getting tested for hepatitis C is important, because treatments can cure most people with hepatitis C in 8 to 12 weeks,” according to the CDC.
Cirrhosis is severe scarring of the liver caused by many forms of liver diseases and conditions, such as HBV, HCV, non-alcoholic steatohepatitis (NASH), or chronic alcoholism.
“Each time your liver is injured — whether by excessive alcohol consumption or another cause, such as infection — it tries to repair itself. In the process, scar tissue forms,” according to the Mayo Clinic. “As cirrhosis gets worse, more and more scar tissue forms, making it difficult for the liver to do its job. Advanced cirrhosis is life-threatening.”
Cirrhosis increases the chance of getting liver cancer; most people who develop liver cancer already have cirrhosis.
Latinos 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,” according to Healthline.
Treatment for cirrhosis depends on the cause and extent of liver damage.
“The goals of treatment are to slow the progression of scar tissue in the liver and to prevent or treat symptoms and complications of cirrhosis,” according to the Mayo Clinic.
While treatment can differ, prevention is the key.
You can help prevent cirrhosis by taking care of your liver, such as maintaining a healthy diet and weight, reducing your risk of hepatitis, and not drinking alcohol.
5. NAFLD and NASH
Nonalcoholic Fatty Liver Disease (NAFLD) or fatty disease is a condition in which fat builds up in your liver, but not through alcohol consumption.
NAFLD, which often has little to no symptoms, can lead to serious health problems.
“Toxic fat buildup can harm your liver and is associated with type 2 diabetes, heart disease, and shortened life span,” according to Taking on Fatty Liver.
Fatty liver disease is common among Latinos.
In this population, it can stem from health conditions commonly associated with the Latino population like obesity, high blood sugar due to prediabetes or type 2 diabetes, high triglyceride and abnormal cholesterol levels, and high blood pressure.
Non-alcoholic Steatohepatitis (NASH) is a type of NAFLD at a more advanced stage.
“NASH in itself isn’t necessarily life-threatening, but the presence of NASH with other risk factors such as older age and diabetes may increase the risk of progression to end-stage liver disease, which is a terminal condition,” according to the Cleveland Clinic.
6. Lack of Access to Screening, Healthcare
Liver cancer and other cancer disparities that Latinos face stem from the many health inequities in the social determinants of health (SDoH).
Cancer screenings explore the body for any signs of cancer.
While screenings usually do not diagnose cancer, they can be the difference between life and death for some.
However, Latinos are screened less often than same other racial/ethnic groups, despite high rates of cancer and/or worse outcomes among this demographic.
Although there are no standard or routine screening tests for liver cancer, some tests are being used or studied to screen for it and/or diagnose it.
These tests include an ultrasound, CT scan, and Alpha-fetoprotein tumor marker.
Screenings for liver cancer are currently recommended for adults with increased risk.
“Being at increased risk doesn’t mean you’ll definitely get liver cancer. But you may need to start regular screening exams. So, if you do get cancer, your doctor finds it at its earliest stage,” according to The University of Texas MD Anderson Cancer Center. “Treatments that aim to cure liver cancer are usually only used for early-stage cancers. If the tumor is found at a later stage, treatment other than surgery may be used. Your team will determine the most appropriate therapy for you.”
Racism and implicit bias in the healthcare system play a large part in Latinos and other minorities delaying preventative care like cancer screenings.
A 2020 study found that Latino (22%) and Black people (27%) are more likely than white people (16%) to believe that race impacts someone’s chances of surviving cancer.
Similarly, 70% of Latinos believe that racism can impact the health care a person receives.
Lack of health insurance is also common among the Latino population.
Latinos have the highest uninsured rates of any racial or ethnic group within the United States.
In 2020, the Census Bureau reported that 49.9% of Hispanics had private insurance coverage, as compared to 73.9% for non-Hispanic whites.
The lack of health insurance among Latinos can further hinder them from visiting the doctor regularly and ultimately serves as a barrier to receiving preventative care.
7. Lack of Access to Culturally Appropriate Care
When Latinos do interact with the healthcare system, they face large barriers, like language.
Being able to communicate accurately and comfortably with health care workers is crucial for Latino patients to develop confidence and trust within the healthcare system.
Understanding each other is just the start. Culturally relevant and competent care and resources are also important.
“Improving both the health literacy and cultural competency of health professionals can improve healthcare consumer satisfaction, improve health outcomes, reduce the cost of care, and reduce health care disparities,” according to a Salud America! resource.
Further, culturally appropriate care can improve screening and preventive care, helping reduce risk factors associated with cirrhosis and liver cancer.
8. Lack of Diverse Participation in Clinical Trials
Latinos represent less than 10% of volunteers in cancer clinical trials.
Clinical trials help researchers learn more and more to help slow, manage, and treat diseases.
The massive underrepresentation of Latinos in clinical trials makes it hard for researchers to develop new treatments for this population, which suffers from conditions like liver cancer.
This is why Dr. Ramirez is creating new ways to encourage Latinos to volunteer for cancer and Alzheimer’s clinical trials.
“To achieve equitable participation of Latinos and other underrepresented groups in clinical research, we need comprehensive approaches that address social and contextual barriers to participation,” Ramirez said.
How can you or someone you know find ways to participate?
Visit the Salud America! clinical trials page and explore ongoing research studies today.
Editor’s Note: This article is part of a collaboration between Salud America! at the Institute for Health Promotion Research at UT Health San Antonio and Bristol Myers Squibb to focus on improving liver health. To find additional content, go here.