Survey Reveals Low Awareness of Chronic Hepatitis B’s Link to Liver Cancer

Nearly 9 in 10 Canadians report having little to no awareness of chronic hepatitis B (CHB), according to new survey findings released for World Hepatitis Day, highlighting persistent gaps in understanding of the infection’s role in liver cancer, prevention, and the importance of testing.

To better understand what these findings reveal about current hepatitis B awareness, barriers to diagnosis, and opportunities to accelerate progress toward elimination, HCPLive spoke with Cary James, chief executive officer of the World Hepatitis Alliance.

The global survey, commissioned and funded by GSK and conducted by Ipsos, found that only 31% of Canadian respondents considered CHB a high cancer risk, despite chronic hepatitis B being a major contributor to liver cancer globally. Additionally, only 14% of respondents reported having previously been tested for CHB, even though the infection affects an estimated 262,000 people in Canada.

The survey included approximately 5000 adults across Japan, Taiwan, China, Germany, and Canada, including 1061 Canadian respondents ≥ 18 years of age. Conducted ahead of World Hepatitis Day on July 28, the survey examined awareness of CHB, perceptions of cancer risk, testing behaviors, and understanding of prevention and treatment options.

CHB is a long-term viral infection that can remain undetected for years because many individuals experience few or no symptoms. Over time, untreated infection can contribute to serious liver complications, including cirrhosis and liver cancer. Globally, CHB accounts for approximately 56% of liver cancer cases and affects more than 240 million people worldwide.

The survey findings highlighted several gaps in public understanding of CHB:

• Only 31% of Canadians identified CHB as a high cancer risk, ranking it lower than risk factors such as regular alcohol use and obesity.
• Nearly 9 in 10 respondents reported knowing little to nothing about CHB.
• Eleven percent said they had never heard of hepatitis B.
• Only 8% believed they were likely to contract CHB.
• Forty-five percent of respondents reported they had never been tested for hepatitis B because they had not considered testing or did not believe they were at risk.
• More than half of respondents (55%) incorrectly believed there was no treatment available for CHB.
• Approximately 3 in 4 respondents were unaware that hepatitis B vaccination can help prevent infection.

The findings come as public health organizations continue efforts to meet the World Health Organization’s goal of eliminating viral hepatitis as a public health threat by 2030. Updated Canadian guidelines emphasize universal screening, infant vaccination, and expanded treatment eligibility for individuals with CHB.

Despite available tools for prevention, diagnosis, and treatment, awareness remains a major challenge.

Q&A: Survey Reveals Low Awareness of Chronic Hepatitis B’s Link to Liver Cancer

HCPLive: When you are looking at these new survey findings, what do they tell you about the current state of hepatitis B awareness?

Cary James: Well, it's not good. I think we knew it was not good, and we've done kind of similar surveys in the past and found the same thing. I mean, I think unfortunately, hepatitis B around the world is under understood, very misunderstood, and very stigmatized in many parts of the world. And yeah, people just don't realize the seriousness of it, or that's even within their community.

So there's so much to do about raising awareness, making people making sure people are aware and of the benefits of getting tested, even if they don't think that they, you know, could have ever been exposed before, and the benefits of treatment.

I mean, I think the cancer information is interesting because we did a survey in I think it was eight countries geographically around the world, and we found that the link between hepatitis and liver cancer is a very good motivator for testing. We asked people if they knew about hepatitis and liver cancer, and we got a very similar result to this survey, where about half said yes. Then if we asked them, "Now that you know that, would you be more likely to get tested?" three quarters said they would be more likely to get tested. This was true from North America to Asia—it was a universal finding.

Then we asked them, "If you tested positive, would you want treatment?" Again, about three quarters said they would want treatment.

So yeah, I think it's startling when you think about more than 200 million people are affected by chronic hepatitis B and just how little it is known and understood.

HCPLive: What do you think these findings reveal about the biggest barriers that prevent people from getting tested or diagnosed earlier?

Cary James: Well, I think if you don't know about it, you can't test for it, right? If people just don't know about hepatitis, if they see a poster, they don't know what it is. They don't know if it could affect them. Even if you're doing awareness campaigns, that's a really big first barrier to overcome.

Number two, in a lot of countries—including some of the countries in this survey, which have quite well-developed health systems—you would expect these numbers to be a bit better. But sometimes accessing hepatitis B testing can be difficult. It's not always readily available through general practitioners, and there's not really an obvious place to get tested.

Plus, there's a really big stigma around hepatitis B, almost universally, I would say. It makes people hesitant to ask for a hepatitis test because they think there might be some judgment attached. It also makes healthcare providers nervous about offering a hepatitis B test if they think the patient would benefit from it because they don't want the patient to feel judged.

We find the same thing with other communicable diseases like HIV. So I think the stigma around hepatitis B is a really big barrier in more ways than just society—it also affects access to healthcare, testing, and treatment.

HCPLive: One of the strongest themes in this survey is that many people don't perceive hepatitis B as a significant health risk. You also mentioned the stigma associated with it. Why do you think hepatitis B has remained outside the public conversation compared with so many other chronic diseases?

Cary James: Well, the diagnosis rates are so low. You probably don't know anyone who has chronic hepatitis B—at least in Europe. In Asia it's probably different. But if you're talking about Canada or Germany, diagnosis rates are quite low, so you've probably never heard of anyone having chronic hepatitis B.

Maybe if you're part of certain communities, like gay men and other men who have sex with men, you've heard someone talk about hepatitis B vaccination to prevent a sexually transmitted infection, but it's not really discussed outside of that context.

We also know that most hepatitis B acquired in adulthood results in an acute infection and doesn't become chronic. Chronic infection is mostly acquired from mother to child, and that's just not really understood.

An example of how under the radar hepatitis B can be comes from the UK. They started a pilot program where emergency departments did opt-out testing for hepatitis B, hepatitis C, and HIV. Everyone who had blood drawn was automatically tested unless they opted out.

Originally it was an HIV pilot, and hepatitis was added later. They expected to find mostly HIV and hepatitis C cases and figured hepatitis B was worth including too. Instead, they found four times more undiagnosed hepatitis B than anything else. They identified thousands of undiagnosed hepatitis B cases in London—so many that hepatology departments wanted to stop emergency department testing because they couldn't manage the number of patients needing follow-up.

No one expected that. Many of the people testing positive were first- and second-generation diaspora communities from high-prevalence countries. If that's true in London, it's probably true in Berlin, Madrid, and other cities with significant migration from high-prevalence countries.

So yes, I think hepatitis B is very misunderstood in most places, both by health systems and by the general population.

HCPLive: When people don't recognize hepatitis B as a long-term health threat, what are the real-world consequences that you're seeing for patients and for public health?

Cary James: Well, untreated hepatitis B can lead to very serious disease. It can lead to cirrhosis, and cirrhosis often leads to liver cancer.

Because those complications often develop later in life, the connection isn't always made that the liver disease could have been caused by hepatitis B.

We're a network of community-based organizations, and we've heard too many stories where generations of families have lost relatives to liver cancer before anyone thought to test for hepatitis B. Then finally someone in the youngest generation gets tested, and they discover hepatitis B has been present in the family for generations.

It's very serious if it's not identified and treated. But many of those deaths are simply recorded as liver disease or liver cancer without connecting them back to hepatitis B.

That's one reason we've worked closely with cancer organizations to make that connection more visible and to incorporate hepatitis B testing into cancer prevention programs.

Last year, at the United Nations High-Level Meeting on Noncommunicable Diseases, we were successful in getting hepatitis testing, treatment, and hepatitis B vaccination recognized as cancer prevention measures and as a way to improve outcomes through earlier diagnosis.

So the impact can be devastating, but it often goes unrecognized if people are never tested.

HCPLive: The World Health Organization has set a goal of eliminating viral hepatitis as a public health threat by 2030. Looking at these survey findings and data, where do you see the biggest opportunities to move us closer to that goal?

Cary James: Well, today is World Hepatitis Day, and we just had a high-level event here in Rio during the AIDS Conference. The Director-General, Dr. Tedros, was the keynote speaker. We also had the Ministers of Health from Brazil and Honduras, along with many other speakers.

I think the really important thing is getting more people tested and more people on treatment. Obviously, we'd like dedicated hepatitis programs, but at the World Hepatitis Alliance we really focus on having a whole health system response to hepatitis.

That means integrating hepatitis into primary care, into cancer and noncommunicable disease programs, and here at the AIDS Conference we've been talking a lot about triple elimination—preventing mother-to-child transmission of HIV, hepatitis, and syphilis together.

As part of that, women are tested for hepatitis B, and if they test positive they're offered treatment. It's about using the infrastructure that's already been built for HIV and expanding it, and that's really gaining momentum.

Another important area is working with harm reduction programs and communities affected by unsafe injection practices. Hepatitis B is often underreported in those settings as well.

So I think there's value in both dedicated hepatitis responses and integrated approaches. Countries sometimes think they need to fund an entirely new program, but they don't. They can make incremental additions to the healthcare systems they already have, and those relatively small changes could make a huge difference.

Additional comments from Cary James:

Cary James: We always say that this could be one of the great global health achievements of our time—eliminating hepatitis B—because we already have all of the tools. And now, with new curative treatments on the horizon, even being able to functionally cure people represents an incredible opportunity.

We're really urging governments and health systems to take up that challenge and be the ones that make this historic decision to do something.

I know we haven't really talked about cures or new therapies, but I think it's important to mention them because of what's happening with HIV treatment.

At the moment, many HIV treatments contain tenofovir disoproxil fumarate (TDF), which also treats hepatitis B. That means there are millions of people—particularly in Africa—with undiagnosed hepatitis B who are unknowingly receiving treatment through their HIV medication.

As HIV care moves toward long-acting injectable therapies that don't contain TDF, we need to make sure those patients' hepatitis B is also being treated. If someone struggles with taking daily HIV medication, they're likely to face the same challenge with daily hepatitis B medication.

That's why developments like functional cures offer real hope. In the future, someone could receive a long-acting injectable for HIV while also accessing a functional cure for hepatitis B. That's still some way off, but when you think about how these innovations are evolving together, they have the potential to completely change the global landscape.

Editor’s Note: Cary James is chief executive officer of the World Hepatitis Alliance.

References

1. GlaxoSmithKline Inc. New survey reveals Canadians underestimate chronic hepatitis B and its link to liver cancer. CNWGroupJuly 28, 2026. Accessed July 28, 2026. https://www.newswire.ca/news-releases/new-survey-reveals-canadians-underestimate-chronic-hepatitis-b-and-its-link-to-liver-cancer-840531048.html