title: The Geographic Distribution of Liver Cancer in Canada Does Not Associate with Cyanobacterial Toxin Exposure.
abstract: BACKGROUND
  The incidence of liver cancer has been increasing in Canada over the past decade, as has cyanobacterial contamination of Canadian freshwater lakes and drinking water sources. Cyanotoxins released by cyanobacteria have been implicated in the pathogenesis of liver cancer.
  
  
  OBJECTIVE
  To determine whether a geographic association exists between liver cancer and surrogate markers of cyanobacterial contamination of freshwater lakes in Canada.
  
  
  METHODS
  A negative binomial regression model was employed based on previously identified risk factors for liver cancer.
  
  
  RESULTS
  No association existed between the geographic distribution of liver cancer and surrogate markers of cyanobacterial contamination. As predicted, significant associations existed in areas with a high prevalence of hepatitis B virus infection, large immigrant populations and urban residences.
  
  
  CONCLUSIONS
  The results of this study suggest that cyanobacterial contamination of freshwater lakes does not play an important role in the increasing incidence of liver cancer in Canada.
authors.affiliation: Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. meaghanlabine@hotmail.com.
authors.forename: Meaghan A
authors.initials: MA
authors.lastname: Labine
authors.affiliation: Cancer Care Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. greenc@cc.umanitoba.ca.
authors.forename: Chris
authors.initials: C
authors.lastname: Green
authors.affiliation: Cancer Care Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. giselle.mak@cancercare.mb.ca.
authors.forename: Giselle
authors.initials: G
authors.lastname: Mak
authors.affiliation: Cancer Care Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. lin.xue@cancercare.mb.ca.
authors.forename: Lin
authors.initials: L
authors.lastname: Xue
authors.affiliation: Cancer Care Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. janet.nowatzki@cancercare.mb.ca.
authors.forename: Janet
authors.initials: J
authors.lastname: Nowatzki
authors.affiliation: Cancer Care Manitoba, University of Manitoba, Winnipeg, MB R3T 2N2, Canada. jane.griffith@cancercare.mb.ca.
authors.forename: Jane
authors.initials: J
authors.lastname: Griffith
authors.affiliation: Morberg Family Chair in Hepatology, Department of Internal Medicine, University of Manitoba, John Buhler Research Centre, 715 McDermot Ave. Winnipeg, MB R3E 3P4, Canada. Gerald.Minuk@umanitoba.ca.
authors.forename: Gerald Y
authors.initials: GY
authors.lastname: Minuk
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000633:toxicity*; D002170:Canada / Q000453:epidemiology; D000458:Cyanobacteria / Q000737:chemistry*; D000087522:Cyanobacteria Toxins; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D004781:Environmental Exposure; D005068:Eutrophication; D005260:Female; D006509:Hepatitis B / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D060106:Lakes / Q000382:microbiology*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000382:microbiology*; D008297:Male; D008387:Marine Toxins / Q000633:toxicity*; D052998:Microcystins / Q000633:toxicity*; D008875:Middle Aged; D015995:Prevalence; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data; D012737:Sex Factors; D014505:Urban Population / Q000706:statistics & numerical data
chemical_list: D001427:Bacterial Toxins; D000087522:Cyanobacteria Toxins; D008387:Marine Toxins; D052998:Microcystins
keywords: blue-green algae; cyanobacteria; cyanotoxins; eutrophication; hepatitis B; hepatitis C; liver cancer; microcystin