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Liver cancer often grows without early symptoms. That makes regular screening very important for people at higher risk. Those with long-term hepatitis B or C infections should get screenings as part of their medical care. Some groups need earlier and more frequent screening.

People with chronic hepatitis B can develop liver cancer even without cirrhosis. Because of this, the American Association for the Study of Liver Diseases (AASLD) recommends:

• Men with hepatitis B start screening at age 40
• Women with hepatitis B start screening at age 50

People waiting for a liver transplant should also have regular screening. Early cancer detection helps them stay eligible and get higher priority for a transplant.

Certain groups have a higher risk and should be closely monitored:

• Family History and Cirrhosis: Anyone with a family history of liver cancer or diagnosed with cirrhosis should get regular screenings, no matter their age.
• Asians and Pacific Islanders: These groups have higher rates of hepatitis B and liver cancer. Liver cancer is a leading cause of death among Asian men and the third most common cancer cause of death among Asian Americans. Younger Asian patients with hepatitis B, especially smokers or those with family history, may need earlier screening.
• Men Born in Africa: Men with chronic hepatitis B often develop liver cancer younger. Screening should begin at age 20.
• People Co-Infected with HIV and Hepatitis B, C, or D: These infections cause faster liver damage and higher cancer risk, so regular screening is very important.
• People with Type 2 Diabetes: Type 2 diabetes can raise the risk of liver cancer. Over time, high blood sugar can damage the liver and lead to conditions like fatty liver disease.

Because liver tumors are often small and hidden under the ribs, they rarely cause symptoms early and can be hard to find during exams. People at average risk usually do not need regular screening. But for those with risk factors like cirrhosis, hepatitis B, or hemochromatosis, doctors may recommend screening every six months.

Regular screening for those at higher risk helps find liver cancer earlier and improves chances for successful treatment.

Why Hepatitis B Risk Is Higher for Asian, Pacific Islander, and African Immigrant Communities

Many Asian American and Pacific Islander people face a higher risk of hepatitis B, a virus that can lead to liver cancer. In these communities, the virus is often passed from mother to child during birth or early childhood, sometimes without causing symptoms.

Hepatitis B is also common among African immigrant communities in the U.S., with men at higher risk than women. Mother-to-child transmission is a leading cause in sub-Saharan Africa. The population of African immigrants in the U.S. has grown rapidly in recent decades, increasing the importance of testing and care.

In both Asian and African immigrant communities, stigma and fear about the disease can prevent people from seeking help. Language barriers, limited access to healthcare, low awareness, cultural differences, and economic challenges also make testing, vaccination, and treatment harder to get. Because hepatitis B often has no symptoms early on, many don’t realize they are infected until liver damage occurs. Overcoming these obstacles through education, outreach, and better healthcare access is essential to prevent liver disease and cancer.