Hepatitis B: A Leading Cause of Liver Cancer in Pakistan

Pakistan has one of the highest rates of hepatitis B in the world. Hepatitis B is a virus that attacks the liver — and over time, it can lead to liver cirrhosis, liver failure, and liver cancer. Understanding hepatitis B is essential to protecting yourself and your family.

What is hepatitis B? Hepatitis B is a viral infection that affects the liver. It is caused by the hepatitis B virus (HBV). The virus is transmitted through contact with infected blood or body fluids.

Common Causes

• Unsafe injections or shared needles
• Blood transfusions without proper screening
• Close contact with someone who has Hep B
• Unprotected sexual contact
• Sharing razors, toothbrushes, nail cutters
• Healthcare or dental exposure
• Household exposure (same home, shared items)

How is hepatitis B spread?

• From mother to baby during childbirth (the most common route in Pakistan)
• Reusing needles or syringes that are not properly sterilised
• Sharing razors, toothbrushes, or nail clippers
• Unscreened blood transfusions
• Unsterilised medical and dental equipment
• Tattooing or piercing with unsterilised tools

Hepatitis B is NOT spread by:

• Hugging, kissing, or holding hands
• Sharing food or water
• Coughing or sneezing
• Mosquitoes

Acute vs chronic hepatitis B:

• Acute infection: The body fights off the virus within 6 months. Most adults clear it naturally. Symptoms include yellowing of the skin (jaundice), fatigue, nausea, and dark urine.
• Chronic infection: The virus stays in the body for life. This is most likely when the infection happens at birth or in early childhood. Chronic hepatitis B can lead to cirrhosis and liver cancer — often decades later.

In Pakistan, many people are infected at birth or in childhood, meaning they carry the virus for decades before developing complications.

How does hepatitis B cause liver cancer? Over years of chronic infection, the virus causes repeated liver damage. The liver tries to repair itself, but this constant cycle of damage and repair can eventually lead to mutations and liver cancer (hepatocellular carcinoma).

What are the symptoms? Most people with chronic hepatitis B have NO symptoms until the liver is severely damaged. This is why it is called a "silent" infection. When symptoms appear, they may include:

• Fatigue
• Yellowing of the skin and eyes (jaundice)
• Abdominal pain (right side)
• Dark urine
• Loss of appetite
• Swelling in the legs or abdomen (in advanced disease)

Prevention — the hepatitis B vaccine: The hepatitis B vaccine is safe, effective, and has been available for decades. It is given as a series of 3–4 shots. In Pakistan, it is part of the routine immunisation schedule for newborns, but many adults were never vaccinated.

If you were born before the vaccine became routine, you should:

1. Get tested for hepatitis B with a simple blood test.
2. If negative, get vaccinated.
3. If positive, see a liver specialist for monitoring and treatment.

What if you already have hepatitis B?

• You are not alone — millions of Pakistanis live with hepatitis B.
• Regular monitoring (every 6 months) with liver ultrasound and AFP blood test can catch liver cancer early.
• Antiviral medications can suppress the virus and greatly reduce the risk of liver cancer and cirrhosis.
• Avoid alcohol completely — it dramatically accelerates liver damage.

What Should You Do? The most important step is vaccination. The Hepatitis B vaccine is safe, effective, and gives long-term protection. You should also:

• Avoid shared needles or blades
• Ensure blood transfusions are properly screened
• Use protection during sexual contact
• Keep personal items separate
• Get tested if you live with someone who has Hep B

When Is It Concerning? Seek medical advice if you experience:

• Yellowing of eyes or skin
• Severe fatigue
• Abdominal swelling

Key message: Hepatitis B is a major cause of liver cancer in Pakistan, but it is preventable through vaccination and treatable with medication. If you have never been tested, get a simple blood test today. If you are negative, get vaccinated. If you are positive, get monitored and treated. Knowing your hepatitis B status can save your life.