Andrea D. Branch Professor of Medicine Division of Liver Diseases Associate Professor of Surgery Icahn School of Medicine at Mount Sinai

Hepatitis C Exposed Black Patients Develop More Aggressive Liver Cancer at Earlier Stage Interview with:

Andrea D. Branch Professor of Medicine Division of Liver Diseases Associate Professor of Surgery Icahn School of Medicine at Mount Sinai

Dr. Branch

Andrea D. Branch PhD
Professor of Medicine
Division of Liver Diseases
Associate Professor of Surgery
Icahn School of Medicine at Mount Sinai What is the background for this study?

Response: Liver cancer is a deadly condition with a high mortality rate. About 90% of people who develop liver cancer have cirrhosis (advanced liver scarring) due to a chronic underlying liver disease. Patients with cirrhosis are advised to undergo liver cancer surveillance. Early detection improves survival, but diagnosis requires more than a blood test, which makes surveillance complex and expensive. Black individuals are more likely to develop liver cancer than white individuals and are more likely to die from it. Black patients also have more advanced liver cancer at the time of diagnosis than Whites. We aimed to identify additional factors that distinguish liver cancer in African Americans, focusing on patients with hepatitis C virus infection, the most common chronic liver disease in people who die from liver cancer in the United States. What are the main findings? Are there co-existing conditions ie HIV, Hepatitis B, diabetes or substance abuse which may make the accelerate the progression to cancer? 

Response: The study was carried out on 1195 liver cancer patients, 390 of whom self-identified as Black.  All the patients had hepatocellular carcinoma, which is the predominant form of liver cancer. Hepatocellular carcinoma in Blacks had a distinctive profile. The tumors were more aggressive and the cancers were more advanced. Tumors were larger and more likely to be multifocal, poorly differentiated, and to show microvascular invasion. Counterintuitively, however, liver function was significantly better in Black individuals and nearly one-third of them did not have liver cirrhosis. This distinctive profile (more advanced tumors, but less advanced liver disease) was present in HCV-exposed Black patients, regardless of their HIV and HBV status. In short, hepatocellular carcinoma developed in Blacks even though many of them lacked the strongest risk factor for progression to liver cancer, i.e., liver cirrhosis. What should readers take away from your report?

Response: Our report has two important take away messages, one in the domain of clinical management and the other in the domain of basic science.

Regarding clinical management, our findings indicate that HCV-exposed Blacks may benefit from participation in liver cancer surveillance even though their liver function is relatively well-preserved and they do not have cirrhosis. This could increase the likelihood that liver cancer would be diagnosed at an early and curable stage.

Regarding basic science, our findings suggest that the environmental, cellular, genetic, and immunological factors leading to hepatocellular carcinoma in Black patients may be somewhat different from the risk factors in white patients. What recommendations do you have for future research as a result of this work?

 Response: Research is needed in three areas. First, studies are needed to determine whether the distinctive profile of liver cancer described here in HCV-exposed patients (worse tumors, but better liver function) is also present in Black individuals with other chronic liver diseases, particularly in those with alcohol-associated liver disease, which is the most common cause of cirrhosis-related death in the United States. This will establish the generalizability of our findings. Second, detailed cell and molecular studies are needed to characterize hepatocellular carcinomas in Blacks and to determine whether their tumors have distinctive mutations and/or immunological features that could be targeted with precision interventions. Third, research is needed to improve strategies for preventing liver cancer, which is a largely preventable cause of death. Specifically, implementation research is needed to improve uptake of treatments for viral hepatitis and for life style modifications. Basic research is needed to delineate and harness liver repair pathways, allowing the safe reversal of liver damage.

Any disclosures? Mount Sinai has received funding from the Prevent Cancer Foundation, CDC/NIOSH, NCI, NIDA, NIDDK, Gilead Sciences, and Boehringer Ingelheim to support research into liver disease risk factors in Dr. Branch’s laboratory. Dr. Sarpel has received funding from the NCI.


Shaltiel, TZheng, SSiderides, CGleeson, EMCarr, JPletcher, ERCohen, NAGolas, BJMagge, DRLabow, DMBranch, ADSarpel, UHepatitis C‐positive Black patients develop hepatocellular carcinoma at earlier stages of liver disease and present with a more aggressive phenotypeCancer2020



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Last Updated on February 25, 2021 by Marie Benz MD FAAD