title: 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.
  
  
  OBJECTIVE
  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 aflatoxin levels, consumption of aflatoxin-contaminated foods, and hepatitis B virus (HBV) prevalence. We calculated the cancer potency of aflatoxin for HBV-postive and HBV-negative individuals, 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.
authors.affiliation: Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15219 , USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.forename: Felicia
authors.initials: F
authors.lastname: Wu
mesh_terms: D000348:Aflatoxins / Q000633:toxicity*; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced / Q000453:epidemiology*; D004032:Diet; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D004781:Environmental Exposure / Q000032:analysis*; D014943:Global Health; D006509:Hepatitis B / Q000453:epidemiology*; D006801:Humans; D008113:Liver Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D009754:Nuts / Q000737:chemistry; D015995:Prevalence; D018570:Risk Assessment; D003313:Zea mays / Q000737:chemistry
chemical_list: D000348:Aflatoxins