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Understanding the link between chronic hepatitis B and liver cancer—and why screening and regular monitoring matter.
For many people living with chronic hepatitis B (CHB), there may be no obvious warning signs; they can feel healthy and go about their daily lives, with no idea that a virus affecting their liver is present. That is one of the challenges surrounding chronic hepatitis B—and one of the reasons screening and ongoing medical follow-up are so important.
“Most people with chronic hepatitis B are asymptomatic,” explains Dr. Julian Hercun, a hepatologist and liver specialist based in Montreal. “This is one of the reasons why we encourage screening, because once someone is screened, their status is known, and therefore they can be linked to care prior to developing any symptoms.”
Worldwide, more than 250 million people are estimated to be living with CHB In Canada, estimates suggest approximately 262,000 people are affected. CHB is most often found in people who have immigrated from regions where the disease is endemic, including parts of Central, Southeast and East Asia and sub-Saharan Africa. For Dr. Hercun, a continuing challenge is ensuring that people know their hepatitis B status and, when necessary, are connected with appropriate care.
The Link Between Chronic Hepatitis B and Liver Cancer
The absence of symptoms does not necessarily mean the absence of liver damage.
Over time, CHB can cause ongoing damage to the liver. This can lead to fibrosis—the development of scar tissue—and, in some people, eventually progress to cirrhosis. Importantly, chronic hepatitis B is also associated with the development of liver cancer.
“While most people are asymptomatic with CHB, there is a proportion of people who, over time, develop damage to the liver that we call fibrosis, which can also lead to cirrhosis,” Dr. Hercun explains. “One of the other complications that can arise with chronic hepatitis B is the occurrence of liver cancer. Progression to cirrhosis or liver cancer are the two outcomes that we most want to prevent in people with chronic hepatitis B.”
Beyond the Diagnosis
Hepatitis B can also have implications for families. One misconception is that infection is always connected with certain adult behaviours, such as unprotected sex or injection drug use. According to Dr. Hercun, this misunderstanding can contribute to stigma surrounding the condition. Many people living with CHB acquired the virus much earlier in life, including through transmission within families. The most common source of infection worldwide is from mother to child during childbirth.
“There is a stigma associated with some of the modes of transmission of Hepatitis B,” Dr. Hercun says. “It’s commonly thought that Hepatitis B can all be transmitted through at-risk behaviour… but actually most people that live with CHB encountered it in their first years of life through transmission from family members.”
“When we do diagnose chronic hepatitis B, we recommend that all family members be screened,” he explains.
In some instances, it is only after one family member is diagnosed that other relatives discover they may also be affected.
Greater awareness can therefore help families understand their health, support one another, and encourage people who may be at risk to speak with a healthcare provider about screening and, where appropriate, vaccination.
Guidelines and Ongoing Care
Current therapies provide excellent control of the virus for many patients, and when combined with regular monitoring, can help reduce the risk of complications such as cirrhosis and liver cancer.
Reflecting this progress, the 2025 Canadian Association for the Study of the Liver (CASL) and Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada) guidelines emphasize the importance of universal screening and expanded eligibility criteria, allowing more patients to benefit from these treatments.
Regular monitoring is also essential, even when someone feels well and their virus is well controlled. Ongoing blood tests and, when appropriate, imaging help healthcare providers track liver health over time, detect signs of fibrosis or cirrhosis earlier, and adjust management to reduce the risk of complications such as liver cancer.
For people living with CHB, knowing their status, staying engaged in ongoing monitoring, and discussing individualized treatment options with their healthcare providers can make a meaningful difference to long-term liver health.
“My best advice for someone who has just been diagnosed with hepatitis B and is wondering whether they should start treatment is to discuss this with their physician,” concludes Dr. Hercun. “There are resources available.”
