Everyone with hepatitis B is at risk for liver cancer. However, the risk is very low for many people with hepatitis B. The groups that are at higher risk for liver cancer include the following:
Older Age is linked with a greater risk of liver cancer (see the graphs above). Men tend to get liver cancer at a younger age than women. For this reason, we start looking for liver cancer in men over the age 40, and women over the age 50.
Cirrhosis clearly increases the risk of liver cancer. Anyone with cirrhosis should get ultrasound screening for liver cancer.
Genetics: liver cancer seems to be very common in some families. If one of your family members has/had liver cancer, you are at higher risk for getting liver cancer as well.
HBV DNA (high viral load). There has been a lot of talk about the dangers of high viral load. This comes from a look back at a large group of older Taiwanese men (the youngest were in their 30s) who were seen in the early 1990s. Some of them developed cancer in the 2000s - about 15% of those with viral load over 4 log IU/mL after 13 years. However, none of these people had a liver biopsy, so we don't know if the people who got cancer didn't already have liver cirrhosis in the early 1990s. They only had an ultrasound, which we now know is not nearly good enough at finding early cirrhosis. What is clear from many other studes is that the risk of hepatitis B is high in an older person with high viral load and cirrhosis. Finally, none of the individuals in this study were treated, so we don't know if treating hepatitis B here would have prevented all those liver cancers.