In a study of 7,498 men of Japanese ancestry in Hawaii, 18 incident cases of primary hepatocellular carcinoma were identified after a follow-up period of 13 years. Sixteen of the 18 patients had stored serum specimens available for analysis. Ten of the 16 had positive serum test results for hepatitis B surface antigen in their original specimens. None of 48 matched control subjects, whose stored serum specimens were also analyzed, had similar positive test results. This finding indicates that hepatitis B surface antigenemia preceded primary hepatocellular carcinoma in many patients.
Nomura A, Stemmermann GN, Wasnich RD. Presence of Hepatitis B Surface Antigen Before Primary Hepatocellular Carcinoma. JAMA. 1982;247(16):2247–2249. doi:10.1001/jama.1982.03320410029024