Aflatoxin contamination of wheat flour and the risk of esophageal cancer in a high risk area in Iran

Ghasemi-Kebria, Fatemeh; Joshaghani, Hamidreza; Taheri, Negar Sadat; Semnani, Shahryar; Aarabi, Mohsen; Salamat, Fatemeh; Roshandel, Gholamreza

doi:10.1016/j.canep.2013.01.010

Cited by 39 publications

(28 citation statements)

References 20 publications

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“…Environmental exposure is associated with esophageal cancer, and even in this small area, the changes in the incidence rate of esophageal cancer were different because of different geographical environments [11]. Some previous studies have found a positive relationship between aflatoxin levels in wheat flour and selenium levels in soil and rice and the risk of esophageal cancer [24, 25]. Other studies have shown that the incidence of esophageal cancer is associated with elevation, suggesting that high altitude might reduce the incidence of esophageal cancer [26].…”

Section: Discussionmentioning

confidence: 99%

The long-term spatial-temporal trends and burden of esophageal cancer in one high-risk area: A population-registered study in Feicheng, China

et al. 2017

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BackgroundFeicheng County is a high-risk area for esophageal cancer in Shandong province, China. It is important to determine the long-term spatio-temporal trends in epidemiological characteristics and the burden of esophageal cancer, especially since the implementation of the national esophageal cancer screening program for early detection and treatment in 2005.MethodsThe data collected in Feicheng County from 2001 to 2012 was extracted from the whole-population cancer registry system. The incidence, mortality, disability-adjusted life years (DALY) and changing trends in esophageal cancer according to age and sex were calculated and described.ResultsThe incidence rate of esophageal cancer in Feicheng was consistently high, and increased significantly for male, but not for female from 2001 to 2012, according to the joinpoint regression analysis. The highest and lowest yearly crude incidence rates were 160.78 and 95.97 per 100000 for males, and 81.36 and 52.17 per 100000 for females. The highest and lowest crude yearly mortality rates were 122.26 and 94.40 per 100000 for males, and 60.75 and 49.35 per 100000for females. Esophageal squamous cell carcinoma was the main pathology type and the tumor location changed significantly from 2001 to 2012. Overall, the DALY remained roughly stable and was estimated as 11.50 for males and 4.90 for females per 1000 people. The burden was mainly caused by premature death. There is an obvious spatial pattern in the distribution of incidence density and burden.ConclusionEsophageal cancer remains a public health issue in Feicheng County with a high incidence, mortality and disease burden. The incidence and burden have obvious spatial heterogeneity, and further studies should be conducted to identify geographical risk factors for precise local prevention and control measures.

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Section: Discussionmentioning

confidence: 99%

The long-term spatial-temporal trends and burden of esophageal cancer in one high-risk area: A population-registered study in Feicheng, China

et al. 2017

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“…40 Researchers also found a positive relationship between aflatoxin level of wheat flour samples and the risk of EC in Golestan. 41 Although an earlier study did not suggest a major role for mycotoxins in EC. 42 A pilot biomarker survey of women also revealed that fusarium mycotoxins exposure was normal compared to other areas of the world.…”

Section: Introductionmentioning

confidence: 92%

Esophageal Cancer in Golestan Province, Iran: A Review of Genetic Susceptibility and Environmental Risk Factors

Gholipour¹,

Islami²,

Roshandel³

et al. 2016

Middle East J Dig Dis

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Esophageal squamous cell carcinoma (ESCC) is an aggressive tumor that is typically diagnosed only when the tumor has gained remarkable size, extended to peripheral tissues, and led to dysphagia. Five-year survival of advanced cancer is still very poor (19%), even with improved surgical techniques and adjuvant chemoradiation therapy. Therefore, early detection and prevention are the most important strategies to reduce the burden of ESCC. Our review will focus on the studies conducted in Golestan province, an area with a high prevalence of ESCC in northern Iran. We review three aspects of the research literature on ESCC: epidemiological features, environmental factors (including substance abuse, environmental contaminants, dietary factors, and human papillomavirus [HPV]), and molecular factors (including oncogenes, tumor suppressor genes, cell cycle regulatory proteins, and other relevant biomarkers). Epidemiological and experimental data suggest that some chemicals and lifestyle factors, including polycyclic aromatic hydrocarbons (PAHs), cigarette smoking, opium use, and hot tea drinking are associated with the development of ESCC in Golestan. HPV infects the esophageal epithelium, but so far, no firm evidence of its involvement in esophageal carcinogenesis has been provided. Some of these factors, notably hot tea drinking, may render the esophageal mucosa more susceptible to injury by other carcinogens. There are few studies at molecular level on ESCC in Golestan. Increasing awareness about the known risk factors of ESCC could potentially reduce the burden of ESCC in the region. Further studies on risk factors, identifying high risk populations, and early detection are needed.

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“…Fumonisins and aflatoxins are types of mycotoxins produced by Fusarium and Aspergillus species of fungi, respectively, and have been associated with oesophageal cancer in other studies in the region, 8,[14][15] and in Iran. 16 No epidemiological studies have been conducted in Malawi to explore potential environmental OC risk factors. One study in Malawi examined the geographic distribution of oesophageal cancer and found no geographic clustering, but this study did not examine specific environmental risk factors.…”

Section: Introductionmentioning

confidence: 99%

Environmental risk factors for oesophageal cancer in Malawi: A case-control study

YB¹,

Rosenberg

LL³

et al. 2015

Mal. Med. J

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AimThere is a high burden of oesophageal cancer in Malawi with dismal outcomes. It is not known whether environmental factors are associated with oesophageal cancer. Without knowing this critical information, prevention interventions are not possible. The purpose of this analysis was to explore environmental factors associated with oesophageal cancer in the Malawian context. MethodsA hospital-based case-control study of the association between environmental risk factors and oesophageal cancer was conducted at Kamuzu Central Hospital in Lilongwe, Malawi and Queen Elizabeth Central Hospital in Blantyre, Malawi. Ninety-six persons with squamous cell carcinoma and 180 controls were enrolled and analyzed. These two groups were compared for a range of environmental risk factors, using logistic regression models. Unadjusted and adjusted odds ratios and 95% confidence intervals (CI) were calculated. ResultsFirewood cooking, cigarette smoking, and use of white maize flour all had strong associations with squamous cell carcinoma of the oesophagus, with adjusted odds ratios of 12.6 (95% CI: 4.2-37.7), 5.4 (95% CI: 2.0-15.2) and 6.6 (95% CI: 2.3-19.3), respectively. ConclusionsSeveral modifiable risk factors were found to be strongly associated with squamous cell carcinoma. Research is needed to confirm these associations and then determine how to intervene on these modifiable risk factors in the Malawian context.

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Aflatoxin contamination of wheat flour and the risk of esophageal cancer in a high risk area in Iran

Cited by 39 publications

References 20 publications

The long-term spatial-temporal trends and burden of esophageal cancer in one high-risk area: A population-registered study in Feicheng, China

The long-term spatial-temporal trends and burden of esophageal cancer in one high-risk area: A population-registered study in Feicheng, China

Esophageal Cancer in Golestan Province, Iran: A Review of Genetic Susceptibility and Environmental Risk Factors

Environmental risk factors for oesophageal cancer in Malawi: A case-control study

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