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IARC MONOGRAPHS ON THE EVALUATION OF CARCINOGENIC ...

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Table 12. Summary of principal case–control studies on liver cancer and aflatoxins<br />

Reference Area Study base Cases Controls Exposure measures Covariate Results Comments<br />

Bulatao-<br />

Jayme et al.<br />

(1982)<br />

Lam et al.<br />

(1982)<br />

Parkin et al.<br />

(1991)<br />

Srivatanakul<br />

et al.<br />

(1991b)<br />

Olubuyide<br />

et al.<br />

(1993a)<br />

Philippines Three<br />

hospitals<br />

Hong Kong 1 university<br />

hospital<br />

Thailand Three<br />

hospitals in<br />

Thailand<br />

Thailand Three<br />

hospitals in<br />

Thailand<br />

Nigeria Hospital in<br />

Ibadan<br />

PLC; n = 90 Patients with normal<br />

liver function;<br />

n = 90<br />

matched by age and<br />

sex<br />

PLC;<br />

n = 107<br />

Chinese<br />

Cholangiocarcinoma;<br />

n = 103<br />

HCC;<br />

n = 65<br />

Primary HCC<br />

diagnosed in<br />

1988; n = 22<br />

Trauma patients,<br />

same hospital.<br />

n = 107<br />

matched by age and<br />

sex<br />

Patients visiting<br />

clinics or admitted to<br />

same hospitals;<br />

matched by age, sex<br />

and residence to<br />

cases; n = 103<br />

Patients visiting<br />

clinics or admitted to<br />

same hospitals;<br />

matched by age, sex<br />

and residence to<br />

cases; n = 65<br />

Matched patients<br />

from gastroenterology<br />

ward;<br />

n = 22<br />

Detailed dietary<br />

history, linked to<br />

measured levels in<br />

sample foods. Also<br />

biomarkers of<br />

aflatoxins<br />

Dietary history,<br />

linked to earlier<br />

market survey of<br />

aflatoxin<br />

contamination<br />

Dietary history.<br />

Aflatoxin–albumin<br />

adducts<br />

Dietary history.<br />

Aflatoxin–albumin<br />

adducts<br />

Serum levels of<br />

aflatoxin<br />

Alcohol and<br />

sociodemographic<br />

variables<br />

HBsAg,<br />

smoking,<br />

alcohol<br />

HBsAg, anti-<br />

HBs, anti-HBc,<br />

anti-OV,<br />

smoking,<br />

alcohol<br />

HBsAg, anti-<br />

HBs, anti-HBc,<br />

anti-OV,<br />

anti-HCV,<br />

smoking,<br />

alcohol<br />

HBsAg<br />

measured but<br />

not included in<br />

analysis of<br />

aflatoxins<br />

Elevated risks with most aflatoxin-contaminated foods<br />

Medium–heavy exp., 15 cases, RR = 14 (p < 0.05)<br />

Heavy exp., 55 cases, RR = 17 (p < 0.05)<br />

Urinary aflatoxins B1 and M1 were significantly<br />

(p < 0.05) higher among cases than among controls.<br />

No differences between cases and controls in reported<br />

consumption of different aflatoxin-contaminated foods<br />

Cases OR 95% CI<br />

Consumption of NR 1.4 0.8–2.7<br />

presumed aflatoxincontaminated<br />

food<br />

Presence of 1 1.0 0.1–16.0<br />

aflatoxin–albumin<br />

adducts<br />

Cases OR 95% CI<br />

Consumption of NR 1.9 Not significant<br />

presumed aflatoxincontaminated<br />

food<br />

Presence of 8 1.0 0.4–2.7<br />

aflatoxin–albumin<br />

adducts<br />

High aflatoxin levels were detected in<br />

5 cases and 1 control (p < 0.05)<br />

2 of these 5 cases were<br />

HBsAg-negative<br />

206<br />

<strong>IARC</strong> <strong>M<strong>ON</strong>OGRAPHS</strong> VOLUME 82

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