Abstract
The aim of this study was to determine the airway exposure of sugar and papermaking factory workers to aflatoxin B1 (AFB1) and to explore the potential association between AFB1 airway exposure and the risk of hepatocellular carcinoma (HCC) in a case-control study. Dust samples were collected from the sugarcane bagasse warehouse, and presser and paper production workshops. Blood samples were collected from 181 workshop employees and 203 controls who worked outside the workshop. AFB1 albumin adducts were detected using a double antibody sandwich enzyme-linked immunosorbent assay (ELISA). To explore the association between AFB1 airway exposure and the risk of HCC, the medical records of 68 HCC patients who worked in a sugar and papermaking factory between January 1994 and December 2013 were analyzed. A questionnaire was used to collect information from 150 healthy controls who worked for the same company and lived near the factory. AFB1 was detected in the dust samples, but could not be detected in any of the rice samples. An analysis of serum samples revealed serum AFB1 albumin adducts in 102 (56.35 %) of the study participants. However, in the control group, only 12 (5.9 %) individuals had detectable levels of AFB1 albumin adducts. Those with airway exposure to Aspergillus flavus-contaminated dust had an elevated risk of HCC compared to those without exposure (odds ratio, 5.24; 95 % confidence interval, 2.77–9.88; P = 0.00). The findings of this study indicate that occupational AFB1 airway exposure might be associated with the risk of AFB1-related HCC among the population that was used in this study. Intervention programs aimed at reducing exposure to inhalational AFB1 are needed urgently. Additional suitably designed, multicenter, prospective studies using large samples are needed to further confirm the results.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common human cancer, with approximately 750,000 new cases occurring worldwide each year [1]
The concentration of aflatoxin B1 (AFB1) in dust samples, which were collected from the sugarcane bagasse warehouse and the presser and paper production workshops, were 7.2±1.30, 8.0±1.23 and 8.6±1.82 μg kg−1, respectively (Table 1)
A statistically significant difference was not detected for the age, gender, body mass index (BMI), daily work periods, hepatitis B virus (HBV) infection, and moldy food intake of the two groups
Summary
Hepatocellular carcinoma (HCC) is the fifth most common human cancer, with approximately 750,000 new cases occurring worldwide each year [1]. Chronic hepatitis B virus (HBV) infection and exposure to aflatoxin B1 (AFB1) are the principal causes of HCC in China and in other regions of the world [4]. Numerous studies have demonstrated that a linear correlation exists between serum AFB1 dietary exposure and the risk of HCC [6,7,8,9,10]. Primary prevention strategies against AFB1 dietary exposure and the HBV, which are the other two principal etiological risk factors in HCC, have offered hope of lowering HCC rates in China [11]. Examples of strategies include HBV vaccination of infants and food safety procedures to control AFB1 contamination
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