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Contents
Introduction
Aflatoxin B1
Geographical distribution of AFB1
Mechanism of action of AFB1 in developing HCC
Prevention of HCC associated with AFB1
Chemoprevention of AFB1-induced HCC and dietary change
Food regulation
Conclusion
Introduction
The incidence of hepatocellular carcinoma (HCC) is rising at an alarming rate and has become a clinical problem worldwide. Data from numerous studies demonstrate that the incidence of HCC has been increasing, with ∼500,000 new cases per year and >600,000 deaths annually (1,2). HCC is the primary liver malignancy, which is the fifth and third leading cause of cancer-related mortality worldwide in females and males, respectively (3,4). HCC is more common in developing countries than in developed countries. However, it has been demonstrated that HCC is also increasing in western countries associated with hepatitis C virus (HCV) infection (5–8). The distribution pattern of HCC reveals geographical variation, ethnic disparities and socioeconomic status with high incidence in Eastern Asia and Africa. There is also an overlap of certain HCC risk factors in their geographical distribution pattern (9–11). Approximately 80% of cases arise in Asia and Africa (12,13). A recent study revealed that China has the highest mortality rate for both males and females, reflecting the prevalence of HBV infection (2), exposure to contaminated food with AFB1 (14) and an increased susceptibility to HCC due to ethnic variation (9).
Among numerous HCC risk factors, hepatitis B virus (HBV) and HCV infections, aflatoxin B1 exposure, heavy alcohol consumption and iron overload are the most documented (15). Epidemiological studies indicate that contamination of food with AFB1 is the major risk factor for human liver cancer (16,17). Areas with a high exposure to AFB1 coincide with areas with a high prevalence of HCC (18,19). AFB1-related HCC is a preventable cancer and thus complete understanding of the mechanism of action of AFB1 and identification of its risk sources are important in minimizing the incidence of AFB1-induced HCC. This may be achieved by establishing interventions, developing chemopreventive agents and adopting dietary changes. In this review, we emphasize the geographical distribution of AFB1-induced HCC, the mechanism of action of AFB1 in HCC development and the prevention of AFB1-induced HCC.
2.Aflatoxin B1
AFB1 is a mycotoxin produced by the common Aspergillus flavus and Aspergillus parasiticus which are common...