Millions with hepatitis B may avoid routine liver cancer checks

A new study [1] by researchers at National Taiwan University Hospital and Academia Sinica has identified a simple blood marker that can pinpoint chronic hepatitis B (CHB) patients at almost no risk of developing liver cancer.

Published in Gut, the research shows that patients with hepatitis B surface antigen (HBsAg) levels below 100 IU/mL face an annual liver cancer risk of just 0.08%  -  comparable to the general population.

The findings come from two of the world’s largest long-term HBV studies, ERADICATE-B and REVEAL-HBV, tracking more than 2,600 inactive CHB patients over 25 years. Validation in a separate NTUH-iMD cohort confirmed that this low-risk threshold is widely applicable.

Notably, around one-third of inactive CHB patients (37%) fall below this HBsAg level, suggesting that millions of people worldwide may now be considered ultra-low risk.

“Patients with HBsAg under 100 IU/mL may have achieved a ‘partial cure’ of hepatitis B,” said Dr Tai-Chung Tseng, lead author. “This could reduce the need for routine liver cancer surveillance and help focus healthcare resources where they are most needed.”

Globally, 254 million people live with CHB, and over 1 million die each year, mostly from liver cancer. Current surveillance protocols are costly and often burdensome, particularly in resource-limited settings. The study suggests that using HBsAg <100 IU/mL as a benchmark could help clinicians safely reduce monitoring for low-risk patients while prioritising higher-risk individuals.

The researchers also highlight that this threshold could serve as a practical endpoint in upcoming HBV cure trials, bridging the gap between current antiviral therapy and functional cures.

More information online

1. Hepatitis B surface antigen level identifies patients with inactive chronic hepatitis B from Asia with HCC risk below surveillance threshold, Tseng TC, Huang SC, Pan MH, et al. published in. Gut. 2025. doi: 10.1136/gutjnl-2025-334911