YOUNG DOCTOR LEARNS HE HAS LIVER CANCER TOO LATE

[Guest guest]

IAC Story #49

YOUNG DOCTOR LEARNS HE HAS LIVER CANCER TOO LATE

From our table at a sidewalk cafe in August 2000, my partner Mark and I took

turns pointing out things that made us smile: a young couple pushing a baby

stroller, a rambunctious puppy tugging at his leash, an elderly couple

holding hands. Our mood was sublime, like the day, as we headed to an

open-air jazz festival near San Francisco with a blanket for napping on a

grassy slope.

Until a sharp stomach pain made Mark wince and double over. Was it the ulcer

he feared? At 30, Mark was a young doctor saddled with debt and the

challenge of building a career after eight sleepless years of medical school

and training. A life with dogs and kids was only a wistful thought. He

crawled into the back seat of the car, cursing and writhing, as I sped him

to the emergency room where he worked.

Mark didn't have an ulcer. An ultrasound of his abdomen showed an ominously

patchy liver. A biopsy confirmed the worst: cancer. His liver was riddled

with so many out-of-control cancerous lesions that neither surgery nor

transplant was possible. Chemotherapy would only slow his inevitable,

insufferable demise 14 months later. But the question remained, how did such

an otherwise perfectly healthy young man, who had a gym-toned body and never

drank, end up with the organ of a hard-living alcoholic twice his age? The

answer was chronic hepatitis B, a virus that can silently harbor in a

healthy liver for decades before unleashing its destructive power.

Mark knew about his hepatitis. He discovered it from blood tests required by

his medical internship. But experts at the prestigious Midwestern hospital

where Mark did his residency told the 26-year-old not to worry. He was a

" healthy " carrier, they said. His symptom-free, nonactive kind of hepatitis

wouldn't have to be monitored for liver cancer until he was in his 50s or

60s. Good advice, if Mark were not an Asian man. (Editor's note: No

hepatitis B carrier, regardless of ethnicity, should wait until age 50 or 60

for liver cancer screening. Screening people with chronic hepatitis B

infection for liver cancer should generally be done every 6-12 months and

should start at the time of hepatitis B diagnosis. Consult a liver

specialist experienced in the treatment of viral hepatitis for appropriate

monitoring guidelines.) Had he or his doctors been trained to know that

Asians are at accelerated risk because they are typically infected as

children, he would have immediately gotten regular ultrasounds and blood

tests to catch the cancer that killed him at 31.

Soon after his diagnosis, Mark was shocked to see a sign on a city bus

advertising Stanford University's " Jade Ribbon Campaign, " a program to raise

awareness of his disease. Was there really a chronic hepatitis B-fueled

epidemic of liver cancer among young Asian-Americans? Are Asians really 10

times more likely to die from liver cancer than a white person? How come he

hadn't heard this before? He was, after all, an Asian doctor practicing in a

region with a population that is nearly one-third Asian. But as a victim

among healers, what happened to Mark precisely illustrates the problem, says

Dr. So, director of Stanford's Asian Liver Center. " Only in a medical

world that relies almost entirely on a Caucasian model for diagnosis and

treatment could such a great health disparity exist, " says So, who lectures

on ethnicity and medicine at Stanford in addition to his surgical and

research duties.

Liver cancer is rampant in Asia. The main culprit is chronic hepatitis B, a

virus transmitted by blood or semen. Exposure to it at childbirth is the

real problem, because that's when the risk of chronic or lifelong infection

is greatest.

Unsanitary living and medical conditions throughout Asia have fueled

hepatitis B infection rates there, as large percentages of mothers

unknowingly pass the virus to their kids. Since it can take 30 years to

manifest, all adult children of Asian immigrants--even those born in the

United States--are at risk. Especially sons. The virus may infect the sexes

equally, but it triggers deadly cancer more often in men.

Mark was born and raised in suburban Chicago by Chinese parents who had

lived in the Philippines. While many newborns are vaccinated for viruses

such as hepatitis in the U.S. today, an entire generation now entering

adulthood was not. Stanford's Dr. So estimates that up to 10 percent of

adult Asian-Americans have chronic hepatitis B and do not know it. Of those,

a quarter will die from liver cancer or failure. That is an alarming number,

since the Asian-American population is one of the country's fastest-growing

minority groups. In California, 30 percent of San Francisco and 12 percent

of Los Angeles is Asian. How many unaware young Asian men will double over

in pain one day like Mark did?

Before Mark died last October, he became a spokesperson for the Jade Ribbon

Campaign (http://liver.stanford.edu), urging all Asians to check their

hepatitis status. Confronting his own mortality wasn't easy for him. " It's

scary to think of your life in months, instead of years, " he told me as his

death approached, our dreams of that day at the sidewalk cafe shattered. I

am still feeling the anger and despair that can engulf you when the person

you love is taken away. It hurts most because Mark Lim was such a

vibrant and vital force to his family, friends, and patients. As a talented

doctor and consummate human being, he had so much potential to do good. Yet

his life was so short, and his death so horrible. In the end, the most he

could do was hope his words might inspire his medical colleagues to

offer--and his Asian peers to seek--the information that can save thousands

like him from his fate. If only they listen.

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