and from one generation to another. In addition, misconceptions about the endemic nature of hepatitis B in the API population and the efficacy of US vaccination programs has led many individuals and health-care providers to overlook the need for testing for APIs. Transmission Most APIs are infected by HBV at birth by their carrier mothers (perinatal infection). Individuals who are infected at birth can develop liver cancer at age 35 or earlier. Also, individuals infected at birth will carry the virus for life, regardless of future vaccination. Transmission is also common during early childhood through direct contact with blood of infected individuals, occurring from contact between open wounds, sharing contaminated toothbrushes or razors, or through contaminated medical/dental tools. Hepatitis B can also be transmitted by blood transfusions, sharing or reusing needles for injection or tattoos, and unprotected sex. Common misconceptions Contrary to common misconceptions Hepatitis B is not transmitted through food/water. Hepatitis B is not transmitted through casual contact, such as hugging or shaking hands. Hepatitis B is not transmitted through kissing, sneezing, or coughing. Hepatitis B is not transmitted through breastfeeding. Vaccination does not help individuals who are already infected with hepatitis B. Mortality risks Without appropriate management and screening, one in four hepatitis B infected individuals (25%) will die from liver cancer or cirrhosis (liver damage leading to scarring and eventually death from liver failure). Some develop cancer as early as 30 years of age. Every year, approximately one million people worldwide die from the disease because they are not diagnosed before the point where current treatment can be effective. Because so many chronically infected individuals feel perfectly healthy even with early liver cancer, the disease can progress without the carrier even knowing. When symptoms do appear, it is often only at the late stages of the disease. All people with chronic hepatitis B infection, whether they feel healthy or sick, are at risk for developing liver cancer or cirrhosis. Finding the cancer when it is small by regular screening remains the best chance of surviving liver cancer. Hepatitis B is one of the largest health threats for Asians and Pacific Islanders. All individuals of Asian descent should request the hepatitis B surface antigen test (HBsAg) to identify infection. Also, individuals should request the hepatitis B surface antibody test (HBsAb) to identify immunity. 5%-10% of those vaccinated do not develop the antibodies and are not protected. The only