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The high incidence of primary liver cancer in East Asia and South-East Asia is largely attributable to the high prevalence of chronic HBV infection in these regions. The early age of infection of people in these regions accounts for significant differences in the clinical course of the disease (with the prolonged immune-tolerance phase setting the scene for development of long-term complications) compared with people born in countries where hepatitis B prevalence is low (who generally become infected as teenagers or adults and enter the immune-clearance phase soon after developing chronic HBV infection). This also explains the former group’s worse prognosis and response to treatment. Screening for hepatitis B has been advocated for at-risk populations born in countries with a high prevalence of HBV infection, although the management pathways for individuals with chronic infection detected by screening programs remain ill defined.