Black people with hepatitis C develop liver cancer sooner than people in other racial groups and the cancer is often more aggressive, but current screening guidelines may not be broad enough to catch these cases early, according to a new study.

Why? Despite often being more advanced, liver cancer in Black people is slower to cause liver damage and scarring, and current guidelines call for liver cancer screening only after such scarring (cirrhosis) has occurred, researchers said.

“Not only is the cancer more aggressive, but we are also not picking it up at the same point in time as we do for other populations,” explained study author Dr. Umut Sarpel, an associate professor of surgery and medical education at the Icahn School of Medicine at Mount Sinai in New York City. “Providers in this arena say that until you develop cirrhosis, you’re fine, but this study tells us that is not really true for everyone.”

While rates of many other cancers are going down, liver cancer is on the rise, according to the U.S. Centers for Disease Control and Prevention. Hepatitis C infection is the main risk factor for hepatocellular carcinoma (HCC), the most common type of liver cancer in adults. Hepatitis C can cause cirrhosis, which can lead to liver cancer.

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