SynthesisEuropean journal of cancer (Oxford, England : 1990)2012
Population attributable risk of aflatoxin-related liver cancer: systematic review and meta-analysis.
Synthesis in European journal of cancer (Oxford, England : 1990), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 135 papers, 12 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
135 citing papers in PubMed, 12 syntheses or guidelines pooled it, 354 citations in OpenAlex.
- Risk factors for hepatocellular carcinoma: an umbrella review of systematic review and meta-analysis.Annals of medicine · 2025Pooled it
- Systematic review and meta-analysis on the prevalence and concentration of aflatoxin BMycotoxin research · 2025Pooled it
- Recent Advancements in Known and Emerging Risk Factors of Hepatocellular Carcinoma.Cancer medicine · 2025Pooled it
- A meta-analysis ofThe Journal of international medical research · 2019Pooled it
- Management of people with early- or very early-stage hepatocellular carcinoma: an attempted network meta-analysis.The Cochrane database of systematic reviews · 2017Pooled it
- Management of people with intermediate-stage hepatocellular carcinoma: an attempted network meta-analysis.The Cochrane database of systematic reviews · 2017Pooled it
- Pooled it
- Analysis of Risk Factors Associated with the Development of Hepatocellular Carcinoma in Chronic HBV-Infected Chinese: A Meta-Analysis.International journal of environmental research and public health · 2016Pooled it
- Ochratoxin A and human health risk: a review of the evidence.Critical reviews in food science and nutrition · 2015Pooled it
- Role of RASSF1A promoter methylation in the pathogenesis of hepatocellular carcinoma: a meta-analysis of 21 cohort studies.Molecular biology reports · 2014Pooled it
- Risk assessment of upper tract urothelial carcinoma related to aristolochic acid.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2013Pooled it
- Genetic polymorphism of the kinesin-like protein KIF1B gene and the risk of hepatocellular carcinoma.PloS one · 2013Pooled it
- Prevalence of Aflatoxin B1 and Other Quality Indicators in Artisanal Peanut Oil from Small-Scale Workshops in Nanning, China.Foods (Basel, Switzerland) · 2026Article
- Aflatoxin exposure and health impacts: global burden and advances in detection technologies.Genes and environment : the official journal of the Japanese Environmental Mutagen Society · 2026Review
- Aflatoxin B1 and food safety: Mechanisms of action associated to Hepatocellular Carcinoma.Archives of microbiology · 2026Review
- Artificially Sweetened and Sugar-Sweetened Beverage Intake and Risk of Liver Cancer.JAMA network open · 2026Article
- Clinical profile and hepatocellular cancer treatment patterns in resource limited settings- a cross-sectional observational study at two tertiary referral teaching hospitals, Addis Ababa, Ethiopia.BMC gastroenterology · 2026Observational
- Peptide hormones and bile acids shaping immune tolerance of the liver: implications and applications.Protein & cell · 2026Review
- Revealing spatiotemporal distribution of aflatoxin B1-related health burdens to optimize monitoring in peanut supply chains.NPJ science of food · 2026Article
- Aflatoxins and Human Health: Global Exposure, Disease Burden, and One Health Strategies.Toxins · 2026Review
75 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 1 institution in 1 country.
Funding
Abstract
backgroundOver 4 billion people worldwide are exposed to dietary aflatoxins, which cause liver cancer (hepatocellular carcinoma, HCC) in humans. However, the population attributable risk (PAR) of aflatoxin-related HCC remains unclear.
methodsIn our 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. We calculated the PAR of aflatoxin-related HCC for each study as well as the combined studies, accounting for HBV status.
resultsSeventeen 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.
conclusionsIn high exposure areas, aflatoxin multiplicatively interacts with HBV to induce HCC; reducing aflatoxin exposure to non-detectable levels could reduce HCC cases in high-risk areas by about 23%. The decreasing PAR of aflatoxin-related HCC reflects the benefits of public health interventions to reduce aflatoxin and HBV.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.