The average age at onset of liver cancer among Bangladeshis is 18 years earlier than the population of other countries, Prof Mamun Al Mahtab Shwapnil, one of the key researchers of the new cancer test development, has said.
"But the big challenge here, like anywhere else, is early diagnosis. It's common both in Bangladesh and India that patients come at an advanced stage when we basically have little to do to cure them. The only option is supportive care like palliation," he told Dhaka Tribune on Monday.
Bangladesh's icddr,b, Bangabandhu Sheikh Mujib Medical University (BSMMU), and a team of clinicians and scientists with the support of the Hong Kong-based biotech firm HKG Epitherapeutics Ltd have developed a simple test that can detect liver cancer early.
Prof Shwapnil, head of the Interventional Hepatology Division at BSMMU, led the research. He was also the lead researcher in developing advanced drugs for hepatitis B-Nasvac.
Dhaka TribuneHe said the new test would revolutionize cancer management around the world.
"Most of the patients come with liver cancer between the ages of 30 and 45, the most productive years in our country. It's because of hepatitis B virus infection," he said, as there had been no provision for giving hepatitis B vaccine in routine immunization once upon a time.
The hepatitis B vaccine was introduced during 2003-2005 into the Expanded Program on Immunization (EPI) in Bangladesh, using the WHO-recommended schedule.
"Early diagnosis is the key to the cure, which the new test can ensure," he said.
Now, liver cancer detection is tricky and costly. First, doctors advise blood tests for Alpha-fetoprotein (AFP). But looking for high AFP levels is not a perfect test for liver cancer. Many patients with liver cancer have normal AFP levels.
Then the doctors suggest ultrasonography or a CT scan. A CT scan gives a better image. But it's costly and also has radiation hazards for a patient who needs to do it every six months.
Other types of cancer, as well as some non-cancerous conditions, can also raise AFP levels.
The new test uses sophisticated sequencing and multiplexing techniques to differentiate HCC samples from normal tissues, other blood samples, and non-HCC tumours, overcoming the limitations of traditional diagnostic methods.
The most prevalent form of primary liver cancer is hepatocellular carcinoma (HCC), which most frequently affects people with chronic liver diseases like NASH and cirrhosis brought on by hepatitis B or C infection.
The research group evaluated the assay on 554 clinical study participants, comprising liver cancer patients, non-liver cancer patients, individuals with chronic hepatitis B, and healthy controls.
The results revealed a liver cancer detection sensitivity of 84.5% at 95% specificity, demonstrating its promising potential for early liver cancer detection, a registry of clinical trials run by the United States National Library of Medicine at the National Institutes of Health.
Prof Shwapnil said he first got the offer to be a partner in the research for publication purposes.
"I said no. I can be involved with one condition: the test has to be made available in Bangladesh," he said. "They agreed."
The BSMMU collected those samples while icddr,b processed them, and the Hong Kong-based lab tested them.
"We are working to start this test commercially. But it's a well-validated study. They have studied it in the Chinese population as well. The results were the same. So we can go commercial anytime," he said.
According to the company, it will cost $5 million to install the complete set-up for starting testing commercially.
"We are also encouraging a local company to bring medicine. Once we detect it early, we need to give people drugs to cure it. There is a drug in the world called S-acetyl methionine (SAMe) which is not being produced by the companies. Because it's not patented and it's cheap. If we can do it in Bangladesh, we can give them a drug after detecting early. It's a vitamin-type drug," he said.
Liver diseases account for 8-12% of admissions in the medicine wards of our public medical college hospitals. It is the third commonest cancer in Bangladesh, next to lung and stomach cancers, Prof Shwapnil said.
Asked if he had any tips on how people can keep liver cancer away, Prof Shwapnil emphasized raising awareness about vaccination against hepatitis B and cutting down on carbs and regular physical exercise to prevent NASH, as these two are the main culprits for liver cancer in Bangladesh.
