Grant Number:	7R01CA153073-05 Interpret this number
Primary Investigator:	Wu, Felicia
Organization:	Michigan State University
Project Title:	The Effect of Aflatoxin Regulation on Global Liver Cancer Risks
Fiscal Year:	2013

DESCRIPTION (provided by applicant): The purpose of this EUREKA application is to develop a multi-factorial modeling tool that can provide decision- makers information on how to set foodborne aflatoxin standards that reduce global liver cancer incidence. Liver cancer (hepatocellular carcinoma) is the 3rd-leading cause of cancer deaths worldwide, with an increasing incidence that parallels the rise in chronic hepatitis B (HBV) and hepatitis C (HCV) infection. Aflatoxin is a potent hepatocarcinogen that synergizes with HBV and HCV to produce 30-fold higher liver cancer risk than either exposure alone. Aflatoxin is produced by the fungi Aspergillus flavus and A. parasiticus in maize and peanuts under warm climatic conditions. Hence, the global populations most at risk of aflatoxin-induced liver cancer are those who consume high levels of maize and peanuts, in less developed countries (LDCs) in the tropics and subtropics where resources to control aflatoxin are scarce. We hypothesize that computational modeling that simulates both public health effects and trade / economic consequences can provide unique insights into how regulatory standards can ameliorate global cancer burden. Over 100 nations have set standards on maximum allowable aflatoxin levels in food. These standards vary widely from nation to nation. Efforts are now being made to harmonize aflatoxin standards globally, to prevent world food trade disputes. We address the question: What should the harmonized aflatoxin standard be to best protect global health? Ironically, setting a very strict standard could result in more cancer cases, for 3 reasons: 1. Rich, food-importing countries would have limited health benefits because of low hepatitis prevalence, while food-exporting LDCs may incur excessive costs to meet such standards. 2. Limiting food export markets could increase poverty in LDCs, which would augment hunger and poor health conducive to increased hepatitis infection and liver cancer risk. 3. To preserve their export markets, Asian and African nations may attempt to export their best-quality food and keep the most highly contaminated food domestically, raising the risk of aflatoxin consumption and liver cancer in parts of the world that currently have the highest rates of hepatitis infection. Because conducting clinical trials is neither practical nor ethical, and retrospective data are limited, computer simulation modeling is an extremely useful technique to examine the consequences of different global aflatoxin standards on food trade and cancer incidence. A powerful attribute of the decision analytic approach to public health is the ability to evaluate several dimensions simultaneously. We seek to create an innovative modeling tool that integrates global liver cancer and hepatitis incidence, aflatoxin exposure through maize and nuts, costs, and technological changes into a single decision-analytic framework. Our specific aim is to determine the effect of selected harmonized aflatoxin standards on both global food export losses and global burden of aflatoxin-induced liver cancer, under current conditions and future scenarios.




A Risk Assessment Of Dietary Ochratoxin A In The United States
Authors: Mitchell N.J. , Chen C. , Palumbo J.D. , Bianchini A. , Cappozzo J. , Stratton J. , Ryu D. , Wu F. .
Source: Food And Chemical Toxicology : An International Journal Published For The British Industrial Biological Research Association, 2017 Feb; 100, p. 265-273.
PMID: 28041933
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Modeling the emetic potencies of food-borne trichothecenes by benchmark dose methodology.
Authors: Male D. , Wu W. , Mitchell N.J. , Bursian S. , Pestka J.J. , Wu F. .
Source: Food And Chemical Toxicology : An International Journal Published For The British Industrial Biological Research Association, 2016 Aug; 94, p. 178-85.
PMID: 27292944
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Ochratoxin A and human health risk: a review of the evidence.
Authors: Bui-Klimke T.R. , Wu F. .
Source: Critical Reviews In Food Science And Nutrition, 2015; 55(13), p. 1860-9.
PMID: 24874522
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Reduced foodborne toxin exposure is a benefit of improving dietary diversity.
Authors: Wu F. , Mitchell N.J. , Male D. , Kensler T.W. .
Source: Toxicological Sciences : An Official Journal Of The Society Of Toxicology, 2014 Oct; 141(2), p. 329-34.
PMID: 25015663
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Evaluating weight of evidence in the mystery of Balkan endemic nephropathy.
Authors: Bui-Klimke T. , Wu F. .
Source: Risk Analysis : An Official Publication Of The Society For Risk Analysis, 2014 Sep; 34(9), p. 1688-705.
PMID: 24954501
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The global burden of disease for skin, lung, and bladder cancer caused by arsenic in food.
Authors: Oberoi S. , Barchowsky A. , Wu F. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2014 Jul; 23(7), p. 1187-94.
PMID: 24793955
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Public health impacts of foodborne mycotoxins.
Authors: Wu F. , Groopman J.D. , Pestka J.J. .
Source: Annual Review Of Food Science And Technology, 2014; 5, p. 351-72.
PMID: 24422587
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Aflatoxin regulations and global pistachio trade: insights from social network analysis.
Authors: Bui-Klimke T.R. , Guclu H. , Kensler T.W. , Yuan J.M. , Wu F. .
Source: Plos One, 2014; 9(3), p. e92149.
PMID: 24670581
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Global maize trade and food security: implications from a social network model.
Authors: Wu F. , Guclu H. .
Source: Risk Analysis : An Official Publication Of The Society For Risk Analysis, 2013 Dec; 33(12), p. 2168-78.
PMID: 23656551
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Global risk assessment of aflatoxins in maize and peanuts: are regulatory standards adequately protective?
Authors: Wu F. , Stacy S.L. , Kensler T.W. .
Source: Toxicological Sciences : An Official Journal Of The Society Of Toxicology, 2013 Sep; 135(1), p. 251-9.
PMID: 23761295
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Risk assessment of upper tract urothelial carcinoma related to aristolochic acid.
Authors: Wu F. , Wang T. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2013 May; 22(5), p. 812-20.
PMID: 23462915
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Global geographical overlap of aflatoxin and hepatitis C: controlling risk factors for liver cancer worldwide.
Authors: Palliyaguru D.L. , Wu F. .
Source: Food Additives & Contaminants. Part A, Chemistry, Analysis, Control, Exposure & Risk Assessment, 2013; 30(3), p. 534-40.
PMID: 23281740
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Population attributable risk of aflatoxin-related liver cancer: systematic review and meta-analysis.
Authors: Liu Y. , Chang C.C. , Marsh G.M. , Wu F. .
Source: European Journal Of Cancer (oxford, England : 1990), 2012 Sep; 48(14), p. 2125-36.
PMID: 22405700
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Aflatoxin regulations in a network of global maize trade.
Authors: Wu F. , Guclu H. .
Source: Plos One, 2012; 7(9), p. e45151.
PMID: 23049773
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Aflatoxins and growth impairment: a review.
Authors: Khlangwiset P. , Shephard G.S. , Wu F. .
Source: Critical Reviews In Toxicology, 2011 Oct; 41(9), p. 740-55.
PMID: 21711088
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