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.