Table 3.

Potential Benefits and Harms of Universal HBV Screening

Category	Benefits	Harms
HBV testing	Test expense is modest and carries low risk
	Excellent test sensitivity and specificity
	Complete identification of HBsAg-positive/anti-HBc–positive patients
	Knowledge of risk of HBV infection is not necessary
	Patients may not admit to having HBV risk factors
	Prevents most cases of HBV reactivation
Antiviral therapy	Relatively inexpensive	Antivirals* adds to patients' financial burden during and for 6 to 12 months after last dose of cancer therapy
		Potential adverse effects (eg, effect on blood counts, chemotherapy drug and dose changes, delay in chemotherapy) of antiviral therapy and cancer therapies have not been systematically studied
		Need follow-up with hepatitis specialist every 3 months; oncologists could monitor if they feel they have sufficient expertise
Systemic cancer therapy	Knowledge of cancer therapy–associated risk of HBV reactivation is not necessary	Unclear treatment of HBsAg-negative/anti-HBc–positive patients receiving cancer therapies not associated with high risk of HBV reactivation
		Uncertainty about cancer therapies not associated with high risk of HBV reactivation; could lead to overtreatment with antiviral prophylaxis in some patients groups:
		HBsAg-negative/anti-HBc–positive patients receiving cancer therapies with low risk of HBV reactivation (not anti-CD20 therapy or stem-cell transplantation)
		HBsAg-positive/anti-HBc–positive patients receiving cancer therapies expected to confer low risk of HBV reactivation (eg, adjuvant hormonal therapy)

Abbreviations: anti-HBc, anti-hepatitis B core antibody; HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus.

^*Antiviral costs estimated between $300 to $1,000 per month without insurance and dependent on specific antiviral drug.