Dramatic reduction of liver cancer incidence in young adults: 28 year follow-up of etiological interventions in an endemic area of China

Abstract

Qidong City, China, has had high liver cancer incidence from endemic hepatitis B virus (HBV) infection and dietary exposure to aflatoxin. Based on etiologic studies, we began interventions in 1980 to reduce dietary aflatoxin and initiate neonatal HBV vaccination. We studied trends in liver cancer incidence rates in the 1.1 million inhabitants of Qidong and examined trends in aflatoxin exposure, staple food consumption, HBV infection markers and annual income. Aflatoxin exposure declined greatly in association with economic reform, increased earnings and educational programs to shift staple food consumption in the total population from moldy corn to fresh rice. A controlled neonatal HBV vaccination trial began in 1983 and ended in November, 1990, when vaccination was expanded to all newborns. Liver cancer incidence fell dramatically in young adults. Compared with 1980-83, the age-specific liver cancer incidence rates in 2005-08 significantly decreased 14-fold at ages 20-24, 9-fold at ages 25-29, 4-fold at ages 30-34, 1.5-fold at ages 35-39, 1.2-fold at ages 40-44 and 1.4-fold at ages 45-49, but increased at older ages. The 14-fold reduction at ages 20-24 might reflect the combined effects of reduced aflatoxin exposure and partial neonatal HBV vaccination. Decrease incidence in age groups >25 years could mainly be attributable to rapid aflatoxin reduction. Compared with 1980-83, liver cancer incidence in 1990-93 significantly decreased 3.4-fold at ages 20-24, and 1.9-fold at ages 25-29 when the first vaccinees were <11 years old.

International trends in liver cancer incidence, overall and by histologic subtype, 1978–2007

“…Aflatoxin abatement programs likely explain the majority of the decrease. 19, 20 For instance, Qidong, China, which has some of the highest reported rates of liver cancer in the world, consumed maize as a primary dietary staple. In 1985, a policy change introduced rice to the region, and since that time, aflatoxin-albumin adduct levels have decreased by 40-fold and liver cancer mortality has decreased by 45%.…”

“…In 1985, a policy change introduced rice to the region, and since that time, aflatoxin-albumin adduct levels have decreased by 40-fold and liver cancer mortality has decreased by 45%. 19, 20 However, neonate HBV vaccination programmes will likely be the major component of additional decreases among future birth cohorts. 19, 20 In 1983–1984, a pilot study for HBV vaccination was undertaken in Qidong.…”

European Code against Cancer 4th Edition: 12 ways to reduce your cancer risk

“…Vaccines prevent cancer by avoiding chronic infection with carcinogenic viruses [33,34]. Screening prevents cancer by detection of curable pre-cancerous lesions, and reduces cancer mortality by early detection of asymptomatic cancers in more curable stages [35].…”

Food safety in developing countries: an overview

“…Reduction in exposure was driven by rapid economic growth that allowed people to switch from maize to rice and to diversify their diets. Little improvement has been seen in Africa (Sun et al, 2013).…”