This study consolidates two decades of research on radioactivity levels in Malaysia, with a particular emphasis on identifying potential High Background Radiation Areas (HBRAs) and assessing the prevailing exposure scenarios. By establishing a classification criterion ≥100 Bq/kg for 226Ra and 232Th, and ≥500 Bq/kg for 40K as Elevated Background Radiation Zones, and ≥1000 Bq/kg as HBRAs, we pinpoint some areas in the Penang, Kedah, Johor, Perak, Pahang, and Selangor States, particularly coastal regions, as areas of concern. This analysis highlights the contributions of thorium- and uranium-rich minerals, acid-intrusive soils, granite formations, and anthropogenic activities, such as the use of phosphate-based fertilizers, as key factors in enhancing radionuclide concentrations. It is assumed that building materials, food products, and other commodities sourced from these regions may lead to unintended radiation exposure for humans and other living organisms, posing various known and unknown health risks. To accurately assess the potential health and environmental impacts, comprehensive cohort studies, ecological evaluations, and laboratory research are essential. Additionally, developing mitigation strategies, including public education through the integration of radiation-related content into existing curricula, is crucial. The findings of this study provide a crucial foundation for developing strategic mitigation measures and shaping future radiological safety regulations in Malaysia.