PhD Candidate Discovers Increasing Risk for Liver Cancer Among US Residents of Mexican Descent

The risk for developing hepatocellular carcinoma (HCC) appears to increase with subsequent generations for Americans of Mexican descent, according to findings from a study of US-born Hispanics/Latinos living in Los Angeles, California.¹

Nicholas Acuna, MPH, a PhD candidate in epidemiology in the Department of Population & Public Health Sciences at the Keck School of Medicine of the University of Southern California led the large population-based prospective study of risk factors for cancer and other chronic diseases among more than 215,000 participants from 5 US racial/ethnic groups in Los Angeles and Hawaii. The analysis focused on self-identified Mexicans for whom information on parental birthplace was available.

Participants born in Mexico with both parents also born in Mexico were designated as first generation. Second generation participants were for those born in the United States with at least 1 parent born in Mexico. Those born in the United States to 2 parents also born in the United States were deemed third generation.

Investigators adjusted for age, sex, body mass index (BMI), smoking status, alcohol intake, history of diabetes, and daily coffee consumption, then assessed participants for HCC risk.

Investigators identified 220 cases of HCC among 32,239 individuals of Mexican descent. At a median follow-up of 23.4 years, the age-adjusted HCC incidence rates per 100,000 people with each successive generation increased from 20.9 cases in the first generation to 27.5 among the second generation individuals, to 34.7 among the third generation individuals. After adjusting for HCC risk factors, Acuna and colleagues concluded that disease risk was 35% greater in the second and 61% greater among the third generation. (Table)

“Third-generation individuals of Mexican descent were more likely to develop liver cancer than those who were considered first generation,” Acuna said. “When we looked at how long people actually lived in the United States, because at baseline, remember, all these people were living in Los Angeles already...they were living in the United States for 15-plus years.”

Acuna said the causes for the increased incidence of HCC are not completely clear, but investigators suspected acculturation was to blame. The data also showed that individuals of Mexican descent living in the United States were more likely to be current smokers, have a greater alcohol intake, consume more coffee, and have an elevated BMI with each successive generation.

“Acculturation is the essentially the adoption of certain lifestyle and behavioral uptakes, that don’t have necessarily beneficial or favorable health outcomes. This can include consuming diets that had more fat and salt. It could include consuming more alcohol or smoking,” Acuna said. “All these different lifestyle behaviors that are mostly attributed to a Western lifestyle have been seen to increase risk for many health outcomes.

“There’s something called the Latino paradox or the Hispanic paradox, which is describing why we are seeing non-Hispanic White people having more unfavorable health outcomes than Latino people, because, in our view, these lifestyle behaviors differ between these populations because of acculturation.”

Acuna and his team focused on HCC because incidence has more than tripled in the United States since the early 1980s. In that time, Latino people have experienced the greatest increase — incidence among Latino people is 2.5 times greater than in White people.² Furthermore, an analysis of 4217 patients showed that, compared with White patients, Hispanic patients were more likely to be older at age of diagnosis, have higher BMI, have diabetes and hypertension, and experienced significantly more nonalcoholic fatty liver disease and alcohol‐related liver disease.³

Acuna said investigators have begun exploring the role living conditions play in acculturation and cancer risk at the neighborhood level. “One of our next steps is to look at and merge information from these people to their neighborhoods. Say, an ethnic enclave, and looking at neighborhood socioeconomic status and seeing if these may also be attributing to why we are seeing such a great increased risk in liver cancer incidence."

Acuna cautioned that these data include all etiologies of liver cancers, in part because they did not have etiology data for all patients. He also noted that investigators only studied people of Mexican descent, so it is not possible to generalize across other Latin American populations.

“There’s a lot more work and further studies that are needed and to have more representation of different populations,” he added.

Acuna is the son of immigrants, so this topic hits home for him. His parents came to the United States from Peru the year he was born. At some point, his last name lost its tilde but his family in Peru still uses the original pronounciation of “Acuña.”

“There are so many health disparities and health inequities that we are experiencing within our communities, and many other communities that have been underrepresented,” he said. “It is very personal. And it’s something that I’m very passionate about pursuing when it comes to research.”

Acuna said fellows and medical trainees can play a unique role in addressing social and cultural biases and removing disparities in care and outcomes. It is important to understand not only patient behavior, but also the cultural context of those behaviors.

“Your neighborhood plays an important role in cancer and risk of development of diseases—understanding where [patients] live in a certain neighborhood,” he said. “Do they have transportation? Are they able to get to, say, a National Comprehensive Cancer Center? All of these things, in conjunction with what we’re thinking about lifestyle behaviors, are very important to understand how this may be impacting their patients.”

References

1. Acuna N. The role of generation on hepatocellular carcinoma risk among US Mexicans in Los Angeles. Presented at: 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; September 16-19, 2022; Philadelphia, Pa. Abst C110.
2. Ahmed F, Perz JF, Kwong S, Jamison PM, Friedman C, Bell BP. National trends and disparities in the incidence of hepatocellular carcinoma, 1998-2003. Prev Chronic Dis. 2008 Jul;5(3):A74.
3. Pomenti S, Gandle C, Abu Sbeih H, et al. Hepatocellular carcinoma in Hispanic patients: trends and outcomes in a large United States cohort. Hepatol Commun. 2020;4(11):1708-1716. doi:10.1002/hep4.1575