Global burden of aflatoxin-induced hepatocellular carcinoma: a risk assessment

Environ Health Perspect. 2010 Jun;118(6):818-24. doi: 10.1289/ehp.0901388. Epub 2010 Feb 19.


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 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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aflatoxins / toxicity*
  • Carcinoma, Hepatocellular / chemically induced
  • Carcinoma, Hepatocellular / epidemiology*
  • Diet
  • Disease Outbreaks / statistics & numerical data*
  • Dose-Response Relationship, Drug
  • Environmental Exposure / analysis*
  • Global Health*
  • Hepatitis B / epidemiology*
  • Humans
  • Liver Neoplasms / chemically induced
  • Liver Neoplasms / epidemiology*
  • Nuts / chemistry
  • Prevalence
  • Risk Assessment
  • Zea mays / chemistry


  • Aflatoxins