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Screening Guide
Liver Health Screening
Liver screening looks for silent problems such as hepatitis B, hepatitis C and fatty liver, so they can be managed before serious damage is done.
Overview
Your liver works quietly in the background, and it rarely complains until it is badly hurt. That is why liver problems such as hepatitis B, hepatitis C and fatty liver often go unnoticed for years.
Liver health screening means checking for these hidden problems before you feel unwell. The aim is simple: find them early, when treatment, vaccination or lifestyle changes can make a real difference.
Hepatitis B is very common worldwide. The World Health Organization (WHO) estimates that 240 million people were living with long-term hepatitis B in 2024, and most people feel nothing when they are first infected.
Who may want to understand this screening
WHO recommends that in places where hepatitis B is common, all adults should be offered a hepatitis B blood test. WHO also advises testing for pregnant women, health-care workers, people who inject drugs, and the partners and family members of someone with hepatitis B. If you have never been tested, it is worth asking.
Hepatitis C is a good test to have at least once, especially if you have ever had a blood transfusion, tattoos or piercings done with unsterile equipment, or shared needles. There is no vaccine for hepatitis C, but WHO notes that modern tablets cure more than 95% of people.
Fatty liver is not something everyone needs to be tested for. European liver, diabetes and obesity societies (EASL, EASD and EASO, 2024) advise looking for fatty liver with scarring in people with type 2 diabetes, people with a large waist plus at least one other metabolic risk (such as high blood pressure or abnormal cholesterol), or people with abnormal liver blood tests. They do not advise screening the general population.
If you have symptoms, please don't wait for a screening appointment. See a doctor soon if you notice yellowing of your eyes or skin, dark urine, a swollen tummy, or unexplained weight loss.
What screening may involve
Most liver screening starts with a simple blood test. A hepatitis B test (HBsAg) and a hepatitis C antibody test show whether you have met these viruses. If either is positive, WHO recommends a follow-up test that measures the virus itself, to confirm whether the infection is still active.
A liver function panel checks liver enzymes and proteins. For fatty liver, your doctor may work out a FIB-4 score, which combines your age with routine blood results to estimate the chance of liver scarring. If the score is not reassuring, a scan that measures liver stiffness (elastography) is the usual next step.
An abdominal ultrasound may be added to look at the liver, gallbladder and nearby organs. For people with long-term hepatitis B and a higher risk of liver cancer, WHO recommends ultrasound plus an AFP blood test every six months.
What screening can — and cannot — tell you
A negative hepatitis B or C test is good news. But if you were exposed very recently, the test may not turn positive yet, so tell your doctor about any recent risk.
Normal liver enzymes do not rule out liver disease. Fatty liver and even scarring can be present with normal blood results, which is why doctors use scores like FIB-4 and, when needed, a stiffness scan.
AFP is not a general screening test for liver cancer. In WHO's 2024 evidence review, checking AFP alone every six months did not clearly reduce deaths from liver cancer. Even ultrasound plus AFP picked up about 63% of early liver cancers, so regular surveillance matters and new symptoms should always be checked.
If a result is abnormal, your doctor will explain what it means and plan the next step. That may be more tests, vaccination, treatment, or referral to a liver specialist.
Practical considerations
Hepatitis blood tests don't need fasting. If you are also having an abdominal ultrasound, you may be asked not to eat for a few hours beforehand so the organs are easier to see. The clinic will let you know.
Bring any previous liver or hepatitis results and your hepatitis B vaccination record if you have one. It also helps to list your medicines, supplements and traditional remedies, and to be honest about how much alcohol you drink.
If your hepatitis B test is negative and you are not protected, ask about vaccination. WHO describes the hepatitis B vaccine as offering nearly 100% protection. If you already have hepatitis B, regular follow-up is important even when you feel well.
Sources
1. Hepatitis B (fact sheet) — World Health Organization, 2026
2. Hepatitis C (fact sheet) — World Health Organization, 2026
3. Guidelines for the prevention, diagnosis, care and treatment for people with chronic hepatitis B infection – Chapter: Surveillance for hepatocellular carcinoma (HCC) among people with CHB — World Health Organization, 2024
4. WHO Guidelines on Hepatitis B and C Testing – Summary of recommendations — World Health Organization, 2017
5. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) — European Association for the Study of the Liver / European Association for the Study of Diabetes / European Association for the Study of Obesity (Journal of Hepatology), 2024
Common questions
Do I need to fast for liver screening?
Not for hepatitis B or C blood tests. You may be asked to fast for a few hours before an abdominal ultrasound, and the clinic will tell you if this applies.
My liver enzymes are normal. Does that mean my liver is healthy?
Not always. Fatty liver and early scarring can be present with normal liver blood tests, so your doctor may also use a FIB-4 score or a scan if you have risk factors.
Is an AFP blood test enough to screen for liver cancer?
No. AFP alone is not a reliable screening test. For people at high risk, such as those with hepatitis B and cirrhosis, WHO recommends ultrasound plus AFP every six months.
Should everyone be checked for fatty liver?
No. European guidelines advise checking people with type 2 diabetes, a large waist with other metabolic risks, or abnormal liver tests, rather than screening everyone.
Can hepatitis C be cured?
Yes, in most cases. WHO notes that modern antiviral tablets cure more than 95% of people, usually in 12 to 24 weeks.