Hepatitis B and Cancer Risk: What You Need to Know
"New research highlights a significant link between past Hepatitis B infections and an increased risk of certain blood cancers. Learn how to protect yourself."
Hepatitis B virus (HBV) is a widespread global infection, especially prevalent in Asia and Africa. While many know about its link to liver cancer (hepatocellular carcinoma or HCC), emerging research suggests a connection to other cancers as well. The good news is that there is a vaccine against HBV and it is recommended for all infants and children. Adults can also get vaccinated to prevent HBV.
Almost 10% of human cancers are triggered by oncovirus infections. While some viruses like human herpesvirus and Epstein-Barr virus are already linked to blood cancers, the role of HBV is still being explored. Because HBV can replicate in lymphoid cells, it might play a role in the development of hematological malignancies.
A recent large-scale study in China investigated the potential link between HBV infection and hematological malignancies. This retrospective cohort study looked at a large number of patients to evaluate the association between past HBV infection and the risk of developing blood cancers.
The Current Burden of Hepatitis B
HepTracker allows users to examine hepatitis B case-surveillance and viral-hepatitis-related mortality data, supporting efforts to understand trends and monitor progress toward eliminating viral hepatitis as a public health threat in the United States. The CDC describes hepatitis B as a vaccine-preventable liver infection caused by HBV, transmitted when infected blood, semen, or another body fluid enters an uninfected person's body. Globally, the WHO's Global hepatitis report 2026 warns that viral hepatitis remains a leading health problem despite the availability of an effective hepatitis B vaccine since the 1990s and antiviral treatments for chronic hepatitis B. In the United States, an estimated 116,514 people were living with liver and intrahepatic bile duct cancer in 2023, and chronic hepatitis B and C infections can cause liver cancer.
Screening Before Cancer Therapy
Patients undergoing anticancer therapy may face HBV reactivation, which can lead to hepatitis flare, liver failure, and death. One study noted that most patients with cancer were not screened for HBV before anticancer therapy and that optimal screening strategies remained unknown. Practical guidance reported that, among cancer patients with chronic or past HBV infection who do not receive antiviral therapy, reactivation risk ranges from 4% to 68% overall and from 40% in a higher-risk group described in the source. These findings highlight both the importance of screening and the limitations of inconsistent implementation.
From Discovery to Prevention
The history of hepatitis-virus discovery is described as a series of cognitive milestones and breakthroughs that revolutionized medicine and public health. The discovery of HBV helped initiate development of the hepatitis B vaccine, identified in the source as the first vaccine not prepared from tissue. Hepatocellular carcinoma has also long been recognized as an important cause of cancer death worldwide, with regional differences in pathology and epidemiology influenced by disease causes, including hepatitis B and C. Historical accounts also emphasize that hepatitis B has often been neglected and stigmatized.
Unveiling the HBV-Blood Cancer Connection: What the Study Showed
The study, conducted at Shanghai Ruijin Hospital, analyzed data from 86,115 patients admitted between 2008 and 2015. The researchers compared two groups: those with prior HBV exposure (indicated by the presence of anti-HBc antibodies) and those without.
- Higher Prevalence of Past HBV Exposure: A significantly larger percentage of patients with hematological malignancies showed evidence of past HBV exposure compared to the control group (61.2% vs. 54.3%).
- Increased Risk of Specific Blood Cancers: The study revealed a higher risk of B-cell non-Hodgkin's lymphoma, acute lymphoblastic leukemia, and multiple myeloma in the HBV-infected group.
- No Association with HBsAg Positivity: Interestingly, current HBV infection (indicated by HBsAg positivity) was not associated with an increased risk of blood cancers in this study. This contrasts with some previous research and may be due to the study's inclusion of all types of hematological malignancies.
Expanding Evidence on HBV-Related Cancer
Recent research continues to examine cancer outcomes associated with hepatitis B beyond the liver. A review reports that the risk of aggressive B-cell non-Hodgkin lymphomas, including diffuse large B-cell, mantle-cell, primary mediastinal large B-cell, and Burkitt lymphomas, is significantly higher in association with HBV infection. In a 2025 study of pediatric T-cell acute lymphoblastic leukemia, the chronic-hepatitis-B-with-active-exacerbation cohort had markedly lower 5-year event-free survival than the HBV-negative cohort, at 13.24% versus 80.58%. Another cited abstract describes HBV as a major global issue because infection is associated with increased hepatocellular-carcinoma risk.
HBV as a Major HCC Risk Factor
Comparative clinical evidence identifies chronic HBV infection as a prominent risk factor for hepatocellular carcinoma. In a single-center study from southern Turkey, chronic HBV infection accounted for 65.7% of identified risk factors, compared with 28.6% for chronic hepatitis C infection. Reviews describe HBV as a DNA-based virus in the Hepadnaviridae family that replicates within hepatocytes and can cause liver disease and increased HCC risk. A practical guide also reports estimates of two billion people with prior HBV exposure and nearly 400 million with chronic infection.
What This Means for You: Taking Control of Your Health
While this research highlights a potential risk, it's important to remember that having HBV exposure doesn't guarantee you'll develop a blood cancer. However, it does underscore the importance of awareness and proactive healthcare. Talk to your doctor about your HBV status, especially if you have a history of HBV infection or live in an area with high HBV prevalence. Regular check-ups and screenings can help detect any potential problems early, when they are most treatable.
Screening Is Part of Cancer Care
ASCO's provisional clinical opinion recommends that all patients anticipating systemic anticancer therapy be tested for HBV. The recommended three-test approach includes hepatitis B surface antigen, total or IgG hepatitis B core antibody, and antibody to hepatitis B surface antigen. The 2020 update builds on ASCO's earlier 2010 provisional clinical opinion and is intended to provide timely, evidence-based clinical direction. Together, these recommendations frame HBV screening and management as an integral part of care for patients receiving treatment for malignant disease.
Looking Beyond Liver Cancer
The CDC's National Prevention Information Network explains that chronic HBV can progress through liver inflammation, fibrosis, and cirrhosis to liver cancer, while emphasizing that infection may be asymptomatic and screening is therefore critical. MD Anderson likewise reports that hepatitis B can cause liver damage and increase liver-cancer risk, and that these risks can be reduced with oral medication when necessary. A 2026 review reports that chronic HBV affects nearly 300 million people worldwide and says accumulating epidemiological and mechanistic evidence suggests possible contributions to extrahepatic malignancies, including gastric cancer. The established HCC relationship and emerging extrahepatic-cancer evidence define important directions for future research.