Population attributable risk of aflatoxin-related liver cancer: Systematic review and meta-analysis
European Journal of Cancer, 03/15/2012
Evidence Based Medicine
Liu Y et al. – In high exposure areas, aflatoxin multiplicatively interacts with HBV to induce hepatocellular carcinoma (HCC); reducing aflatoxin exposure to non–detectable levels could reduce HCC cases in high–risk areas by about 23%. The decreasing population attributable risk (PAR) of aflatoxin–related HCC reflects the benefits of public health interventions to reduce aflatoxin and HBV.Methods
- In the systematic review and meta-analysis of epidemiological studies, summary odds ratios (ORs) of aflatoxin-related HCC with 95% confidence intervals were calculated in HBV+ and HBV- individuals, as well as the general population.
- The authors calculated the PAR of aflatoxin-related HCC for each study as well as the combined studies, accounting for HBV status.
- Seventeen studies with 1680 HCC cases and 3052 controls were identified from 479 articles.
- All eligible studies were conducted in China, Taiwan, or sub-Saharan Africa.
- The PAR of aflatoxin-related HCC was estimated at 17% (14-19%) overall, and higher in HBV+(21%) than HBV-(8.8%) populations.
- If the one study that contributed most to heterogeneity in the analysis is excluded, the summarised OR of HCC with 95% CI is 73.0 (36.0-148.3) from the combined effects of aflatoxin and HBV, 11.3 (6.75-18.9) from HBV only and 6.37 (3.74-10.86) from aflatoxin only.
- The PAR of aflatoxin-related HCC increases to 23% (21-24%).
- The PAR has decreased over time in certain Taiwanese and Chinese populations.