Comparative Cancer Risk Assessment to Estimate Risk of Hepatocellular Carcinoma Attributable to Dietary Exposure of Aflatoxin through a Surrogate (Maize) in Eastern Mediterranean Region (Iran) as Compared to East (Canada) and West Pacific (China) Regions

Background: Hepatocellular Carcinoma (HCC) is the most common primary liver malignancy and the second leading cause of cancer related deaths worldwide. Chronic infection with Hepatitis B (HBV) and Hepatitis C (HCV) virus are significant risk factors of HCC. Aflatoxins, type of mycotoxin, produced by fungi Aspergillus flavus and Aspergillus parasiticus are potent liver carcinogen. This cancer risk assessment was conducted with aim to compare risk of aflatoxin attributable HCC in the countries of Eastern Mediterranean region with countries of region of Americas (East) and Western Pacific region (West). Methods: Cancer risk assessment was conducted using data on maize consumption for select countries from food balance sheets (FBS) database of the Food and Agriculture Organization of the United Nations (FAO), aflatoxin contamination level of the maize and chronic HBV infection prevalence from 37 publications retrieved from literature review. Results: Risk of HCC attributable to aflatoxin exposure in Iran is 0.02 (0.0001 – 0.095) HCC cases per 100,000 chronic HBV negative population which reflects in 15-75 HCC cases per year. Among the select WHO regions, most cases occur in China and Philippines from Western Pacific region and Mexico from region of Americas. Conclusion: Risk of aflatoxin related HCC in Iran is comparable to high income countries from region of Americas and Western Pacific region