Hepatocellular cancer (HCC) is the 4th leading cause of cancer-related death worldwide1. Chronic infection with hepatitis B (CHB) is one of the most frequent causes of HCC. In the United States, Europe, Egypt and Japan hepatitis B (HBV) related HCC accounts for 20% of HCC, while in Africa and Asia it is around 60%. In 1981 Beasley et al.2 reported for the first time the association with CHB and HCC in a cohort of Taiwanese men. Since the discovery of the hepatitis B virus in 1965, multiple carcinogenic mechanisms have been documented3. In patients with hepatitis B related cirrhosis the annual incidence of HCC is particularly high in comparison with other aetiologies, up to 2% to 5%4.   

Despite the introduction of HBV vaccine in 1983, 350 million people are still chronically infected with HBV globally. HBV vaccine is known as the first anti-cancer vaccine, ever since universal infant vaccination in Taiwan demonstrated a significant reduction in HCC incidence in a cohort of children in the 1990s5.