Talking critical aspects of liver cancer with Dr. Zamzam Ali and Jessica Trihn

October is Liver Cancer Awareness Month. This month we sat down with Dr. Zamzam Ali and Jessica Trihn to chat about all things liver cancer from signs and symptoms, to early detection, risk reduction strategies, and community engagement. Dr. Ali and Jessica Trihn will be our special expert guests at our next Fireside Chat, happening October 16!

What is your educational background? What intrigued you about your field of specialty?  

Dr. Zamzam Ali: I hold a bachelor's degree in medicine and surgery from Ahfad University for Women in Sudan and a master’s degree of science in public health for development from the London School of Hygiene and Tropical Medicine. I am passionate about improving the health and wellbeing of the population and ways to bridge the gap between healthcare systems and patients to design a more inclusive and patient-centered health system.

Jessica Trihn: I completed my undergraduate degree in neuroscience at Yale College and received a culinary certificate after college at Le Cordon Bleu London. I am now an MD/MS student at Mayo Clinic Alix School of Medicine with my thesis focused on assessing socioeconomic disparities in eye care at Mayo Clinic's retina injection clinic. I have been a member of the Somali Health Advisory Committee (SHAC) since coming to Rochester over 3 years ago. Seeing from my own experiences growing up with parents who are refugees from Vietnam, I've always felt community-engaged work was crucial for gaining trust and truly understanding the needs of communities who are underserved. I love my work with SHAC and through community-based organizations that aspire to collaborate with communities to create initiatives. 

What is liver cancer and how is it typically diagnosed?

Dr. Ali: Liver cancer is a type of cancer that affects the liver cells and leads to the development of abnormal cells and tissue that form tumors within the organ. There are many types of liver cancer, and each has its own signs and symptoms, however, some types don’t show any symptoms and hence it is important to have routine screening. Liver cancer can be diagnosed using a blood test that shows the liver function and any abnormalities in some protein levels, imaging tests such as ultrasound, CT scan, MRI, and liver tissue biopsy where a small amount of tissue is removed and sent to the laboratory for cancer testing.

Are there any preventative measures that people can take against getting liver cancer?

Dr. Ali: There are some modifiable risk factors that can cause long-term damage to your liver and can be prevented or treated for a better outcome.

This can include the following:

• Infections: such as hepatitis B and C viruses. Screening for these infections can help improve your health and prevent future progress to cancer.
• Excessive alcohol consumption: Drinking a lot of alcohol can cause liver damage and can lead to liver cancer, cirrhosis, or both.
• The environment: Exposure to aflatoxin which is a fungus that is common in some regions around the world such as Asia and Africa.
• Other chronic diseases and health issues like diabetes and autoimmune diseases can impact the liver.

What health disparities exist regarding liver cancer? 

Dr. Ali: Hepatocellular carcinoma is the third leading cause of cancer mortality and the most lethal of the major cancers globally (1). African Americans in the United States experience a significantly higher liver cancer incidence rate (10.2 per 100,000) compared to White Americans (6.3 per 100,000) (2). Health disparities in liver cancer among diverse U.S. populations are influenced by a complex interplay of factors, including structural inequities in access to healthcare services.

How is your research or work advancing understanding of liver cancer and how we prevent/diagnose it? 

Dr. Ali: My research focuses on improving health disparities in access to liver healthcare services for individuals of African descent. We try to understand social determinants of health factors that influence hepatocellular carcinoma prognosis rates in hepatitis C patients of African origin compared to other racial/ethnic groups. Additionally, I am interested in tackling the burden of hepatitis C as a major risk factor of liver cancer in Africa by scaling up elimination efforts in the continent. Understanding these disparities is crucial for developing targeted and equitable interventions that have a positive and long-term impact on improving health outcomes. 

How is your community-engaged work helping to prevent/diagnose liver cancer in the communities you serve?

Jessica Trihn: As a member of SHAC, we have engaged through various avenues in the community to increase understanding of liver diseases. From tabling at community health fairs to holding educational seminars, we've been able to speak directly with community members and healthcare professionals about disparities in liver disease screening and management. We've also created educational videos in both English and Somali that can be shared more broadly. We still have much more work to do but it is exciting to see the impact of these initiatives. Learn more about SHAC’s work in Minnesota. 

References:

1. Konyn P, Ahmed A, Kim D. Current epidemiology in hepatocellular carcinoma. Expert Review of Gastroenterology & Hepatology. 2021;15(11):1295-307.
2. Muhimpundu S, Conway RBN, Warren Andersen S, Lipworth L, Steinwandel MD, Blot WJ, et al. Racial Differences in Hepatocellular Carcinoma Incidence and Risk Factors among a Low Socioeconomic Population. Cancers. 2021;13(15):3710.