Chronic hepatitis B affects more than 250 million people worldwide, and hepatocellular carcinoma is a leading cause of death among people with chronic hepatitis B whether cirrhosis is present or not. Routine surveillance with liver ultrasound and serum AFP have been shown to be associated with higher rates of curative treatment and higher survival rates. Surveillance for hepatocellular carcinoma is recommended for all chronic hepatitis B patients with cirrhosis. For patients with chronic hepatitis B without cirrhosis, surveillance for hepatocellular carcinoma is currently not recommended for patients for lower risk patients such as men younger than 40 years or women younger than 50 years by some professional society guidelines. However, there are additional risk factors for hepatocellular carcinoma that can be taken into consideration to individualize risk for a given patient such as age, sex, activity of disease, and family history. Several HCC risk scores in patients with HBV infection incorporating risk factors including older age, male sex, family history of HCC, higher DNA levels, and the presence of cirrhosis exist and can aid in shared decision-making between providers and patients, given the relative lack of data for populations outside surveillance recommendations, including immune tolerant and inactive carrier patients.