Global burden of Aflatoxin-induced hepatocellular carcinoma: A risk assessment

Abstract

Background: Hepatocellular carcinoma (HCC), or liver cancer, is the third leading cause of cancer deaths worldwide, with prevalence 16-32 times higher in developing countries than in developed countries. Aflatoxin, a contaminant produced by the fungi Aspergillus flavus and Aspergillus parasiticus in maize and nuts, is a known human liver carcinogen. Objectives: We sought to determine the global burden of HCC attributable to aflatoxin exposure. Methods: We conducted a quantitative cancer risk assessment, for which we collected global data on food-borne aflv as well as the uncertainty in all variables, to estimate the global burden of aflatoxin-related HCC. Results: Of the 550,000-600,000 new HCC cases worldwide each year, about 25,200-155,000 may be attributable to aflatoxin exposure. Most cases occur in sub-Saharan Africa, Southeast Asia, and China where populations suffer from both high HBV prevalence and largely uncontrolled aflatoxin exposure in food. Conclusions: Aflatoxin may play a causative role in 4.6-28.2% of all global HCC cases.