Hepatocellular cancer (HCC) is a common gastrointestinal malignancy in hepatitis cases which is difficult to detect in early stages. Alpha fetoprotein (AFP) is a tumor marker which has been introduced for screening but in Southeast Asia where the rate of hepatitis B seropositivity is very high, the diagnostic benefit is still doubtful. Here, a literature review of three Thai reports was conducted, covering 4,295 cases. The overall diagnostic activity showed sensitivity, specificity, false positives and false negatives of 73.5 %, 98.9 %, 26.5 % and 1.1 %, respectively. Thus the sensitivity is insufficient for screening purposes and serum AFP can not be recommended for hepatitis B carriers over standard tests.