Fumonisins are Fusarium mycotoxins that occur in corn and corn-based foods. They are toxic to animals and at least one analogue, fumonisin B1, is carcinogenic to rodents. Their effect on human health is unclear, however, fumonisins are considered to be risk factors for cancer and possibly neural tube defects in some heavily exposed populations. It is therefore important to minimize exposures in these populations. Cleaning corn to remove damaged or moldy kernels reduces fumonisins in foods while milling increases their concentration in some and reduces their concentration in other products. Fumonisins are water-soluble and nixtamalization (cooking in alkaline water) lowers the fumonisin content of food products if the cooking liquid is discarded. Baking, frying, and extrusion cooking of corn at high temperatures ( > or = 190 degrees C) also reduces fumonisin concentrations in foods, with the amount of reduction achieved depending on cooking time, temperature, recipe, and other factors. However, the chemical fate of fumonisins in baked, fried, and extruded foods is not well understood and it is not known if the reduced concentrations result from thermal decomposition of fumonisins or from their binding to proteins, sugars or other compounds in food matrices. These possibilities might or might not be beneficial depending upon the bioavailability and inherent toxicity of decomposition products or the degree to which bound fumonisins are released in the gastrointestinal tract. In this review the affects of cooking and processing on the concentration and chemical structure of fumonisins as well as the toxicological consequences of known and likely fumonisin reaction products are discussed.