Mycotoxin exposure is associated with increased risk of esophageal squamous cell carcinoma in Huaian area, China

BACKGROUND: Consumption of moldy food has previously been identified as a risk factor for esophageal squamous cell carcinoma (ESCC) in high-risk countries; however, what contributing roles these dietary carcinogenic mycotoxins play in the etiology of ESCC are largely unknown. METHODS: A mycotoxin biomarker-incorporated, population-based case-control study was performed in Huaian area, Jiangsu Province, one of the two high-risk areas in China. Exposure biomarkers of aflatoxins (AF) and fumonisins (FN) were quantitatively analyzed using HPLC-fluorescence techniques. RESULTS: Among the cases (n = 190), the median levels of AF biomarker, serum AFB(1)-lysine adduct, and FN biomarker, urinary FB(1), were 1.77 pg/mg albumin and 176.13 pg/mg creatinine, respectively. Among the controls (n = 380), the median levels of AFB(1)-lysine adduct and urinary FB(1) were 1.49 pg/mg albumin and 56.92 pg/mg creatinine, respectively. These mycotoxin exposure biomarker levels were significantly higher in cases as compared to controls (p < 0.05 and 0.01, respectively). An increased risk to ESCC was associated with exposure to both AFB(1) and FB(1) (p < 0.001 for both). CONCLUSIONS: Mycotoxin exposure, especially to AFB(1) and FB(1), was associated with the risk of ESCC, and a greater-than-additive interaction between co-exposures to these two mycotoxins may contribute to the increased risk of ESCC in Huaian area, China.