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If tests find hepatitis B surface antigen positive, get a liver ultrasound plus an alpha-fetoprotein test every 6 months, let your doctor's assessment decide whether you take antiviral drugs, and once you start, don't stop on your own

  • Moderate value
  • Evidence A
  • Buys life
  • Disputed
  • Costs a little
  • Takes minutes
  • Long-term effort

In plain words

People carrying the hepatitis B virus who had a liver ultrasound and an alpha-fetoprotein test every six months had nearly 40% fewer deaths from liver cancer in a Shanghai trial. The more virus in the blood, the more liver cancer later. For people whose livers are already badly fibrotic or cirrhotic, taking antiviral drugs cut liver cancer by about half. Most of the drugs have to be taken long term, and if you stop on your own the virus easily rebounds.

Cost

A visit to a liver disease or infectious disease clinic every 6 months, with a blood draw and an ultrasound; costs vary by place. For those who need antiviral drugs, the National Healthcare Security Administration (国家医保局) says that after the centralized procurement (集采) of entecavir, a year of the drug cost fell to a little over 100 CNY. The hard part is going on schedule when you feel nothing, and taking the drug without a break.

What you get

A randomized trial in Shanghai: 18816 people aged 35 to 59, all infected with the hepatitis B virus or with a history of chronic hepatitis. The screening group was invited every 6 months for an alpha-fetoprotein test and an ultrasound, and the control group was not screened. Alpha-fetoprotein is a blood test marker that often rises with liver cancer. Liver cancer deaths were 32 in the screening group and 54 in the control group. The liver cancer death rate was 83.2 versus 131.5 per 100,000 (10万) people. The screening group was 0.63 times the control group (95% CI 0.41–0.98, confidence range), about 37% lower. Of the liver cancers found in the screening group, 46.5% had surgery to remove them, versus only 7.5% in the control group. A follow-up study in Taiwan: 3653 people aged 30 to 65 who were surface-antigen positive, followed for an average of 11.4 years, with records only and no assigned groups. The more virus in the blood at enrollment, the more liver cancer later. With fewer than 300 copies per milliliter of virus, there were 108 liver cancers per 100,000 (10万) person-years. With 1,000,000 (100万) copies per milliliter or more, there were 1152. The cumulative share who got liver cancer was 1.3% and 14.9% respectively. After adjusting for sex, age, smoking, drinking, transaminases and cirrhosis, the pattern of more virus and more liver cancer still held. A randomized trial in Asia: 651 patients with chronic hepatitis B who already had severe liver fibrosis or cirrhosis. One group took lamivudine and one took a placebo, for a median of 32.4 months. Liver cancer was 3.9% versus 7.4%, a risk about half as high (HR 0.49, P=0.047). Disease progression was 7.8% versus 17.7% (HR 0.45, about 55% lower). The 2022 guideline of the Chinese Medical Association (中华医学会) states that people with chronic hepatitis B virus infection should have an abdominal ultrasound and an alpha-fetoprotein test every 6 months to screen for liver cancer. High-risk people should do so at least every 3 to 6 months. Carriers who do not need medicine for now should have a blood count, liver function, viral markers, alpha-fetoprotein and an ultrasound every 6 to 12 months. As soon as they meet the conditions for medicine, treatment should start right away. For people with detectable virus in the blood, antiviral treatment is recommended over age 30, whether or not the transaminases are high. The same goes for people with a family member who got cirrhosis or liver cancer from hepatitis B. The oral drugs the guideline recommends are entecavir and tenofovir types. The guideline states that most people need to take the drug long term, and that after stopping, a high share have the virus rebound

Notes

Disputed: some people do not accept the conclusion of the Shanghai trial. A 2003 Cochrane review recalculated it with its own method. The difference in liver cancer deaths came out not significant (OR 0.81, 0.54–1.22). The 2012 update said the trial had a high risk of bias and that the figures in several reports did not match, so no conclusion could be drawn. So "check every six months" rests on this one disputed trial plus guidelines. Lamivudine is an old drug, and 49% of people in the trial developed resistance mutations; the guideline now recommends entecavir and similar drugs. Whether to take medicine and whether you can stop depends on the viral load, transaminases, degree of liver fibrosis and family history, and your doctor decides. For people who are not yet infected, testing the hepatitis B "two-and-a-half" panel (两对半) and getting vaccinated: see §1.14 (testing the hepatitis B "two-and-a-half" panel). Hepatitis C is a different disease; see §1.45 (hepatitis C antibody). Alcohol damages the liver; see §2.19 (drink little or no alcohol). The beneficiary is mainly you.

Evidence grade
A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
Sources
  1. Zhang BH, Yang BH, Tang ZY (2004). Randomized controlled trial of screening for hepatocellular carcinoma. Journal of Cancer Research and Clinical Oncology, 130(7), 417-422. https://doi.org/10.1007/s00432-004-0552-0
  2. Chen CJ, Yang HI, Su J, et al.; REVEAL-HBV Study Group (2006). Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA, 295(1), 65-73. https://doi.org/10.1001/jama.295.1.65
  3. Liaw YF, Sung JJ, Chow WC, et al.; Cirrhosis Asian Lamivudine Multicentre Study Group (2004). Lamivudine for patients with chronic hepatitis B and advanced liver disease. New England Journal of Medicine, 351(15), 1521-1531. https://doi.org/10.1056/NEJMoa033364
  4. 中华医学会肝病学分会, 中华医学会感染病学分会 (2022). 慢性乙型肝炎防治指南（2022 年版）. 中华肝脏病杂志, 30(12), 1309-1331. https://doi.org/10.3760/cma.j.cn501113-20221204-00607
  5. 同一指南的英文版：You H, Wang F, Li T, et al. (2023). Guidelines for the Prevention and Treatment of Chronic Hepatitis B (version 2022). Journal of Clinical and Translational Hepatology, 11(6), 1425-1442. https://doi.org/10.14218/JCTH.2023.00320
  6. Wun YT, Dickinson JA (2003). Alpha-fetoprotein and/or liver ultrasonography for liver cancer screening in patients with chronic hepatitis B. Cochrane Database of Systematic Reviews, CD002799. https://doi.org/10.1002/14651858.CD002799（反方）
  7. Aghoram R, Cai P, Dickinson JA (2012). Alpha-foetoprotein and/or liver ultrasonography for screening of hepatocellular carcinoma in patients with chronic hepatitis B. Cochrane Database of Systematic Reviews, CD002799.pub2. https://doi.org/10.1002/14651858.CD002799.pub2（反方）
  8. 国家医疗保障局 (2025). 中国医保惠民生 积跬步、至长远（七）：医药集采规范化制度化常态化：「乙肝治疗一线用药恩替卡韦，过去患者吃一年的费用大约5000元……集采后恩替卡韦年费用降到100多元」. https://www.nhsa.gov.cn/art/2025/12/29/art_14_19172.html

Mentioned in

Translated from the Chinese original. Original book, section 16, tip 11. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer