Skip to main content
SpringerLink
Log in

Hepatocarcinogenesis Induced by Environmental Exposures in the Middle East

  • Chapter
  • First Online:
Liver Cancer in the Middle East

  • 414 Accesses

Abstract

The incidence of hepatocellular carcinoma (HCC) has been rising in the Middle East. Liver cancer is a major concern, particularly in Egypt. Although hepatitis infections are suggested to be the main causes of HCC, environmental exposures also contribute to high morbidity and mortality rates of this disease. Aflatoxins are one of the main causes of HCC. Aflatoxin B1 is classified as a “human carcinogen,” and it can contribute to the increasing incidence of HCC in the Middle East countries. In hepatitis patients, aflatoxin exposure is a major risk factor for primary liver cancers. Alcohol consumption and smoking can also lead to HCC. Moreover, exposure to arsenic and certain chemicals, particularly to vinyl chloride, may also be an underlying factor for HCC. This chapter will focus on environmental carcinogenesis in the Middle East, their mechanism of action, and studies performed in Middle East on aflatoxins, alcohol, smoking, arsenic, and vinyl chloride.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Available from: https://www.cancer.org/cancer/liver-cancer/about/what-is-key-statistics.html.

  2. Kirk GD, Bah E, Montesano R. Molecular epidemiology of human liver cancer: insights into etiology, pathogenesis and prevention from the Gambia, West Africa. Carcinogenesis. 2006;27(10):2070–82.

    Article  CAS  PubMed  Google Scholar 

  3. Parkin DM, Bray F, Devesa S. Cancer burden in the year 2000. The global picture. Eur J Cancer. 2001;37:4–66.

    Article  Google Scholar 

  4. Raoul J-L Natural history of hepatocellular carcinoma and current treatment options. Seminars in nuclear medicine; 2008: Elsevier.

    Google Scholar 

  5. Okuda K. Hepatocellular carcinoma: recent progress. Hepatology. 1992;15(5):948–63.

    Article  CAS  PubMed  Google Scholar 

  6. Sell S. Cellular origin of cancer: dedifferentiation or stem cell maturation arrest? Environ Health Perspect. 1993;101(suppl 5):15–26.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Palmer Beasley R, Lin CC, Chien CS, Chen CJ, Hwang LY. Geographic distribution of HBsAg carriers in China. Hepatology. 1982;2(5):553S–6S.

    Article  Google Scholar 

  8. Unsal H, Yakicier C, Marcais C, Kew M, Volkmann M, Zentgraf H, et al. Genetic heterogeneity of hepatocellular carcinoma. Proc Natl Acad Sci. 1994;91(2):822–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bressac B, Kew M, Wands J, Ozturk M. Selective G to T mutations of p53 gene in hepatocellular carcinoma from southern Africa. Nature. 1991;350(6317):429–31.

    Article  CAS  PubMed  Google Scholar 

  10. Wr R, Coetzee GA, Olumi AF, Jones PA. 5-Methylcytosine as an endogenous mutagen in the human LDL receptor and p53 genes. Science. 1990;249(4974):1288–90.

    Article  Google Scholar 

  11. Hsu I, Metcalf R, Sun T, Welsh J, Wang N, Harris C. Mutational hot spot in the p53 gene in human hepatocellular carcinomas. Nature. 1991;350(6317):427–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hollstein M, Sidransky D, Vogelstein B, Harris CC. p53 mutations in human cancers. Science. 1991;253(5015):49–53.

    Article  CAS  PubMed  Google Scholar 

  13. Ferlay J. GLOBOCAN 2000. Cancer incidence, mortality and prevalence worldwide, version 1.0. IARC cancerbase. 2001.

    Google Scholar 

  14. Bosch FX, Ribes J, Cléries R, Díaz M. Epidemiology of hepatocellular carcinoma. Clin Liver Dis. 2005;9(2):191–211.

    Article  PubMed  Google Scholar 

  15. International Agency for Research on Cancer. Liver. Source: Globacan. Available from: https://gco.iarc.fr/today/data/factsheets/cancers/11-Liver-fact-sheet.pdf.

  16. Available from: https://www.worldlifeexpectancy.com/cause-of-death/liver-cancer/by-country/.

  17. Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118(12):3030–44.

    Article  CAS  PubMed  Google Scholar 

  18. Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. J Hepatol. 2001;35(3):421–30.

    Article  CAS  PubMed  Google Scholar 

  19. El-Serag HB. Hepatocellular carcinoma: an epidemiologic view. J Clin Gastroenterol. 2002;35(5):S72–S8.

    Article  PubMed  Google Scholar 

  20. Velázquez RF, Rodríguez M, Navascués CA, Linares A, Pérez R, Sotorríos NG, et al. Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis. Hepatology. 2003;37(3):520–7.

    Article  PubMed  Google Scholar 

  21. C. CANCERDATABASES IN THEARABWORLD.

    Google Scholar 

  22. Available from: https://www.worldlifeexpectancy.com/middle-east/liver-cancer-cause-of-death.

  23. Poustchi H, Sepanlou SG, Esmaili S, Mehrabi N, Ansarymoghadam A. Hepatocellular carcinoma in the world and the middle East. Middle East J Dig Dis. 2010;2(1):31.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Fakeeh M, Zaki AM. Hepatitis C: prevalence and common genotypes among ethnic groups in Jeddah, Saudi Arabia. Am J Trop Med Hyg. 1999;61(6):889–92.

    Article  CAS  PubMed  Google Scholar 

  25. Fani A, Fani I, Eshrati B, Samadian P, Fani P, GHORISHI Y. screening for hepatocellular carcinoma in chronic carriers of hepatitis B and C in markazi province, iran. 2007.

    Google Scholar 

  26. Shamseddine A, Sibai A-M, Gehchan N, Rahal B, El-Saghir N, Ghosn M, et al. Cancer incidence in postwar Lebanon: findings from the first national population-based registry, 1998. Ann Epidemiol. 2004;14(9):663–8.

    Article  PubMed  Google Scholar 

  27. Yaghi C, Sharara A, Rassam P, Moucari R, Honein K, Boujaoude J, et al. Hepatocellular carcinoma in Lebanon: Etiology and prognostic factors associated with short-term survival. World J Gastroenterol. 2006;12(22):3575.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Abbas Z, Abbas M, Abbas S, Shazi L. Hepatitis D and hepatocellular carcinoma. World J Hepatol. 2015;7(5):777.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Uzunalimoğlu Ö, Yurdaydin C, Çetinkaya H, Bozkaya H, Şahin T, Çolakoğlu S, et al. Risk factors for hepatocellular carcinoma in Turkey. Dig Dis Sci. 2001;46(5):1022–8.

    Article  PubMed  Google Scholar 

  30. Okuda K, Tabor E. Liver cancer. Churchill Livingstone; 1997.

    Google Scholar 

  31. Salim EI, Moore MA, Al-Lawati JA, Al-Sayyad J, Bazawir A, Bener A, et al. Cancer epidemiology and control in the Arab world-past, present and future. Asian Pac J Cancer Prev. 2009;10(1):3–16.

    PubMed  Google Scholar 

  32. Lehman EM, Soliman AS, Ismail K, Hablas A, Seifeldin IA, Ramadan M, et al. Patterns of hepatocellular carcinoma incidence in Egypt from a population-based cancer registry. Hepatol Res. 2008;38(5):465–73.

    Article  PubMed  Google Scholar 

  33. Chen CJ, Chen C, Wu M, Kuo T-L. Cancer potential in liver, lung, bladder and kidney due to ingested inorganic arsenic in drinking water. Br J Cancer. 1992;66(5):888–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Neuberger J, Forman D, Doll R, Williams R. Oral contraceptives and hepatocellular carcinoma. Br Med J (Clin Res Ed). 1986;292(6532):1355–7.

    Article  CAS  Google Scholar 

  35. Palmer JR, Rosenberg L, Kaufman DW, warshauer ME, Stolley P, Shapiro S. Oral contraceptive use and liver cancer. Am J Epidemiol. 1989;130(5):878–82.

    Article  CAS  PubMed  Google Scholar 

  36. Mandishona E, MacPhail AP, Gordeuk VR, Kedda MA, Paterson AC, Rouault TA, et al. Dietary iron overload as a risk factor for hepatocellular carcinoma in Black Africans. Hepatology. 1998;27(6):1563–6.

    Article  CAS  PubMed  Google Scholar 

  37. Available from: https://www.cancer.org/cancer/liver-cancer/causes-risks-prevention/risk-factors.html.

  38. Bosch FX, Ribes J, Borràs J, editors. Epidemiology of primary liver cancer. Seminars in liver disease. Thieme Medical Publishers, Inc; 1999.

    Google Scholar 

  39. Belpomme D, Irigaray P, Hardell L, Clapp R, Montagnier L, Epstein S, et al. The multitude and diversity of environmental carcinogens. Environ Res. 2007;105(3):414–29.

    Article  CAS  PubMed  Google Scholar 

  40. https://monographs.iarc.fr/agents-classified-by-the-iarc.

  41. Cancer IAfRo. Preamble to the IARC Monographs. Scientific Review and Evaluation http://monographs.iarc.fr/ENG/Preamble/currentbscientificintro0706.php Published. 2006.

  42. https://monographs.iarc.fr/list-of-classifications.

  43. Shephard GS. Aflatoxin analysis at the beginning of the twenty-first century. Anal Bioanal Chem. 2009;395(5):1215–24.

    Article  CAS  PubMed  Google Scholar 

  44. Shephard GS. Determination of mycotoxins in human foods. Chem Soc Rev. 2008;37(11):2468–77.

    Article  CAS  PubMed  Google Scholar 

  45. Organization WH, Cancer IAfRo. Some naturally occurring substances: food items and constituents, heterocyclic aromatic amines and mycotoxins. IARC Monogr Eval Carcinog Risk Chem Hum. 1993;56

    Google Scholar 

  46. Giray B, Girgin G, Engin AB, Aydın S, Sahin G. Aflatoxin levels in wheat samples consumed in some regions of Turkey. Food Control. 2007;18(1):23–9.

    Article  CAS  Google Scholar 

  47. Giray B, Atasayar S, Sahin G. Determinatıon of ochratoxin A and total aflatoxin levels in corn samples from Turkey by enzyme-linked immunosorbent assay. Mycotoxin Res. 2009;25(2):113–6.

    Article  CAS  PubMed  Google Scholar 

  48. Kensler TW, Roebuck BD, Wogan GN, Groopman JD. Aflatoxin: a 50-year odyssey of mechanistic and translational toxicology. Toxicol Sci. 2011;120(suppl_1):S28–48.

    Article  CAS  PubMed  Google Scholar 

  49. Erkekoğlu P, Şahin G, Baydar T. A special focus on mycotoxin contamination in baby foods: their presence and regulations. FABAD J Pharm Sci. 2008;33:51–66.

    Google Scholar 

  50. Kew MC. Aflatoxins as a cause of hepatocellular carcinoma. J Gastrointest Liver Dis. 2013;22(3)

    Google Scholar 

  51. Probst C, Njapau H, Cotty PJ. Outbreak of an acute aflatoxicosis in Kenya in 2004: identification of the causal agent. Appl Environ Microbiol. 2007;73(8):2762–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Matsuda Y, Wakai T, Kubota M, Osawa M, Sanpei A, Fujimaki S. Mycotoxins are conventional and novel risk biomarkers for hepatocellular carcinoma. World J Gastroenterol: WJG. 2013;19(17):2587.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Woloshuk CP, Shim W-B. Aflatoxins, fumonisins, and trichothecenes: a convergence of knowledge. FEMS Microbiol Rev. 2013;37(1):94–109.

    Article  CAS  PubMed  Google Scholar 

  54. Bryden WL. Mycotoxins in the food chain: human health implications. Asia Pac J Clin Nutr. 2007;16(S1):95–101.

    CAS  PubMed  Google Scholar 

  55. Poirier MC. Chemical-induced DNA damage and human cancer risk. Nat Rev Cancer. 2004;4(8):630–7.

    Article  CAS  PubMed  Google Scholar 

  56. Kotsonis FN, Burdock GA. Food toxicology. In: Casarett and Doull’s toxicology: the basic science of poisons; 2008. p. 1191–236.

    Google Scholar 

  57. Gross-Steinmeyer K, Eaton DL. Dietary modulation of the biotransformation and genotoxicity of aflatoxin B1. Toxicology. 2012;299(2–3):69–79.

    Article  CAS  PubMed  Google Scholar 

  58. Friedman M, Rasooly R. Review of the inhibition of biological activities of food-related selected toxins by natural compounds. Toxins. 2013;5(4):743–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Ueng Y-F, Shimada T, Yamazaki H, Guengerich FP. Oxidation of aflatoxin B1 by bacterial recombinant human cytochrome P450 enzymes. Chem Res Toxicol. 1995;8(2):218–25.

    Article  CAS  PubMed  Google Scholar 

  60. Wild CP, Gong YY. Mycotoxins and human disease: a largely ignored global health issue. Carcinogenesis. 2010;31(1):71–82.

    Article  CAS  PubMed  Google Scholar 

  61. Croy RG, Wogan GN. Temporal patterns of covalent DNA adducts in rat liver after single and multiple doses of aflatoxin B1. Cancer Res. 1981;41(1):197–203.

    CAS  PubMed  Google Scholar 

  62. Smela ME, Hamm ML, Henderson PT, Harris CM, Harris TM, Essigmann JM. The aflatoxin B1 formamidopyrimidine adduct plays a major role in causing the types of mutations observed in human hepatocellular carcinoma. Proc Natl Acad Sci. 2002;99(10):6655–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Gursoy-Yuzugullu O, Yuzugullu H, Yilmaz M, Ozturk M. Aflatoxin genotoxicity is associated with a defective DNA damage response bypassing p53 activation. Liver Int. 2011;31(4):561–71.

    Article  CAS  PubMed  Google Scholar 

  64. Sancar A, Lindsey-Boltz LA, Ünsal-Kaçmaz K, Linn S. Molecular mechanisms of mammalian DNA repair and the DNA damage checkpoints. Annu Rev Biochem. 2004;73(1):39–85.

    Article  CAS  PubMed  Google Scholar 

  65. Burma S, Chen BP, Murphy M, Kurimasa A, Chen DJ. ATM phosphorylates histone H2AX in response to DNA double-strand breaks. J Biol Chem. 2001;276(45):42462–7.

    Article  CAS  PubMed  Google Scholar 

  66. Bennett RA, Essigmann JM, Wogan GN. Excretion of an aflatoxin-guanine adduct in the urine of aflatoxin B1-treated rats. Cancer Res. 1981;41(2):650–4.

    CAS  PubMed  Google Scholar 

  67. Sabbioni G, Skipper PL, Büchi G, Tannenbaum SR. Isolation and characterization of the major serum albumin adduct formed by aflatoxin B 1 in vivo in rats. Carcinogenesis. 1987;8(6):819–24.

    Article  CAS  PubMed  Google Scholar 

  68. Bhat R, Krishnamachari K. Follow-up study of aflatoxic hepatitis in parts of western India. Indian J Med Res. 1977;66(1):55–8.

    CAS  PubMed  Google Scholar 

  69. Wang J-S, Huang T, Su J, Liang F, Wei Z, Liang Y, et al. Hepatocellular carcinoma and aflatoxin exposure in Zhuqing village, Fusui county, People’s Republic of China. Cancer Epidemiol Prevent Biomarkers. 2001;10(2):143–6.

    CAS  Google Scholar 

  70. Akhter I, Gupta A. Viral hepatitis with special reference to hepatitis B virus infection in India: an overview. J Indian Med Assoc. 2013;111(2):121–2. 6

    PubMed  Google Scholar 

  71. Shepard DS, Undurraga EA, Halasa YA. Economic and disease burden of dengue in Southeast Asia. PLoS Negl Trop Dis. 2013;7(2):e2055.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Karoney MJ, Siika AM. Hepatitis C virus (HCV) infection in Africa: a review. Pan African Med J. 2013;14(1)

    Google Scholar 

  73. Paterson RR, Lima N. Toxicology of mycotoxins. Molecular, clinical and environmental toxicology. Springer; 2010. p. 31–63.

    Book  Google Scholar 

  74. Moudgil V, Redhu D, Dhanda S, Singh J. A review of molecular mechanisms in the development of hepatocellular carcinoma by aflatoxin and hepatitis B and C viruses. J Environ Pathol Toxicol Oncol. 2013;32(2)

    Google Scholar 

  75. Chen C-H, Wang M-H, Wang J-H, Hung C-H, Hu T-H, Lee S-C, et al. Aflatoxin exposure and hepatitis C virus in advanced liver disease in a hepatitis C virus–endemic area in Taiwan. Am J Trop Med Hyg. 2007;77(4):747–52.

    Article  CAS  PubMed  Google Scholar 

  76. Johnson NM, Qian G, Xu L, Tietze D, Marroquin-Cardona A, Robinson A, et al. Aflatoxin and PAH exposure biomarkers in a US population with a high incidence of hepatocellular carcinoma. Sci Total Environ. 2010;408(23):6027–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Leong Y-H, Rosma A, Latiff AA, Izzah AN. Associations of serum aflatoxin B1–lysine adduct level with socio-demographic factors and aflatoxins intake from nuts and related nut products in Malaysia. Int J Hyg Environ Health. 2012;215(3):368–72.

    Article  CAS  PubMed  Google Scholar 

  78. Wild CP, Hudson GJ, Sabbioni G, Chapot B, Hall AJ, Wogan GN, et al. Dietary intake of aflatoxins and the level of albumin-bound aflatoxin in peripheral blood in the Gambia, West Africa. Cancer Epidemiol Prev Biomarkers. 1992;1(3):229–34.

    CAS  Google Scholar 

  79. Bedard LL, Massey TE. Aflatoxin B1-induced DNA damage and its repair. Cancer Lett. 2006;241(2):174–83.

    Article  CAS  PubMed  Google Scholar 

  80. Shen H-M, Ong C-N, Lee B-L, Shi C-Y. Aflatoxin B1-induced 8-hydroxydeoxyguanosine formation in rat hepatic DNA. Carcinogenesis. 1995;16(2):419–22.

    Article  CAS  PubMed  Google Scholar 

  81. Wang J-S, Groopman JD. DNA damage by mycotoxins. Mutat Res. 1999;424(1–2):167–81.

    Article  CAS  PubMed  Google Scholar 

  82. Olivier M, Hussain SP. Caron dFC, Hainaut P, Harris CC. TP53 mutation spectra and load: a tool for generating hypotheses on the etiology of cancer. IARC Sci Publ. 2004;157:247.

    Google Scholar 

  83. Farazi PA, Depinho RA. The genetic and environmental basis of hepatocellular carcinoma. Discov Med. 2009;6(35):182–6.

    Google Scholar 

  84. Sajan MP, Satav JG, Bhattacharya RK. Alteration of energy-linked functions in rat hepatic mitochondria following aflatoxin B1 administration. J Biochem Toxicol. 1996;11(5):235–41.

    Article  CAS  PubMed  Google Scholar 

  85. Pasupathy K, Krishna M, Bhattacharya RK. Alterations of phosphatidylinositol signal transduction pathway in hepatic mitochondria following aflatoxin B1 administration. Indian J Exp Biol. 1999;37(9):876–80.

    CAS  PubMed  Google Scholar 

  86. Yardim N, Mollahaliloglu S. The situation of cancer in Turkey and evaluation of its coherence with international indicators. Cancer Control Turkey. 2006:111–28.

    Google Scholar 

  87. Shanks ET, Statkiewicz WR, Llwelleyn GC, Dashek WV. Tissue distribution and hepatic ultrastructural effects of aflatoxin B1 in Japanese quail. Pol Arch Weter. 1986;26(1–2):117–31.

    CAS  PubMed  Google Scholar 

  88. Rainbow L, Maxwell SM, Hendrickse RG. Ultrastructural changes in murine lymphocytes induced by aflatoxin B1. Mycopathologia. 1994;125(1):33–9.

    Article  CAS  PubMed  Google Scholar 

  89. Obasi SC. Effects of scopoletin and aflatoxin B1 on bovine hepatic mitochondrial respiratory complexes, 2: a-ketoglutarate cytochrome c and succinate cytochrome c reductases. Z Naturforsch C J Biosci. 2001;56(3–4):278–82.

    Article  CAS  PubMed  Google Scholar 

  90. Pier A. Immunomodulation in aflatoxicosis. Diagnosis of mycotoxicoses. Springer; 1986. p. 143–8.

    Book  Google Scholar 

  91. Reddy R, Taylor M, Sharma R. Studies of immune function of CD-1 mice exposed to aflatoxin B1. Toxicology. 1987;43(2):123–32.

    Article  CAS  PubMed  Google Scholar 

  92. RichardJ J, Thurston J, Pier A. Effects of mycotoxins on immunity. In: Rosenberg P, editor. Toxins: animal, plant and microbial, vol. 19. New York; 1987. p. 801–17.

    Google Scholar 

  93. Paterson RRM, Lima N. How will climate change affect mycotoxins in food? Food Res Int. 2010;43(7):1902–14.

    Article  CAS  Google Scholar 

  94. Franceschi S, Montella M, Polesel J, La Vecchia C, Crispo A, Dal Maso L, et al. Hepatitis viruses, alcohol, and tobacco in the etiology of hepatocellular carcinoma in Italy. Cancer Epidemiol Prev Biomarkers. 2006;15(4):683–9.

    Article  CAS  Google Scholar 

  95. Abdel-Hafez A, Saber SM. Mycoflora and mycotoxin of hazelnut (Corylus avellana L.) and walnut (Juglans regia L.) seeds in Egypt. Zentralbl Mikrobiol. 1993;148(2):137–47.

    Article  CAS  PubMed  Google Scholar 

  96. Selim MI, Popendorf W, Ibrahim MS, Sharkawy SE, Kashory ESE. Anatoxin B1 in common Egyptian foods. J AOAC Int. 1996;79(5):1124–9.

    Article  CAS  PubMed  Google Scholar 

  97. El-Kady I, Youssef M. Survey of mycoflora and mycotoxins in Egyptian soybean seeds. J Basic Microbiol. 1993;33(6):371–8.

    Article  CAS  PubMed  Google Scholar 

  98. Abdallah MF, Krska R, Sulyok M. Occurrence of ochratoxins, fumonisin B2, aflatoxins (B1 and B2), and other secondary fungal metabolites in dried date palm fruits from Egypt: a mini-survey. J Food Sci. 2018;83(2):559–64.

    Article  CAS  PubMed  Google Scholar 

  99. Hifnawy M, Mangoud AM, Eissa MH, Edin EN, Mostafa Y, Abouel-Magd Y, et al. 8-The role of aflatoxin-contaminated food materials and hcv in developing hepatocellular carcinoma in Sharkia Governorate, Egypt. Journal-Egyptian Society Of Parasitology. 2004;34(1; SUPP):479–88.

    CAS  Google Scholar 

  100. Aly SE. Distribution of aflatoxins in product and by-products during glucose production from contaminated corn. Food Nahrung. 2002;46(5):341–4.

    Article  CAS  PubMed  Google Scholar 

  101. Madbouly AK, Ibrahim MI, Sehab AF, Abdel-Wahhab MA. Co-occurrence of mycoflora, aflatoxins and fumonisins in maize and rice seeds from markets of different districts in Cairo, Egypt. Food Addit Contam B. 2012;5(2):112–20.

    Article  CAS  Google Scholar 

  102. Soliman K. Incidence, level, and behavior of aflatoxins during coffee bean roasting and decaffeination. J Agric Food Chem. 2002;50(25):7477–81.

    Article  CAS  PubMed  Google Scholar 

  103. Abdallah MF, Krska R, Sulyok M. Mycotoxin contamination in sugarcane grass and juice: first report on detection of multiple mycotoxins and exposure assessment for aflatoxins B1 and G1 in humans. Toxins. 2016;8(11):343.

    Article  PubMed Central  CAS  Google Scholar 

  104. Abdallah MF, Girgin G, Baydar T. Mycotoxin detection in maize, commercial feed, and raw dairy milk samples from Assiut City, Egypt. Vet Sci. 2019;6(2):57.

    Article  Google Scholar 

  105. Aziz NH, Youssef YA. Occurrence of aflatoxins and aflatoxin-producing moulds in fresh and processed meat in Egypt. Food Addit Contam. 1991;8(3):321–31.

    Article  CAS  PubMed  Google Scholar 

  106. Abd-Elghany SM, Sallam KI. Rapid determination of total aflatoxins and ochratoxins A in meat products by immuno-affinity fluorimetry. Food Chem. 2015;179:253–6.

    Article  CAS  PubMed  Google Scholar 

  107. Turner PC, Loffredo C, Kafrawy SE, Ezzat S, Eissa SAL, Daly ME, et al. Pilot survey of aflatoxin–albumin adducts in sera from Egypt. Food Addit Contam. 2008;25(5):583–7.

    Article  CAS  Google Scholar 

  108. Polychronaki N, Wild CP, Mykkänen H, Amra H, Abdel-Wahhab M, Sylla A, et al. Urinary biomarkers of aflatoxin exposure in young children from Egypt and Guinea. Food Chem Toxicol. 2008;46(2):519–26.

    Article  CAS  PubMed  Google Scholar 

  109. Sayed HA, El Ayyat A, El Dusoki H, Zoheiry M, Mohamed S, Hassan M, et al. A cross sectional study of hepatitis B, C, some trace elements, heavy metals, aflatoxin B1 and schistosomiasis in a rural population, Egypt. J Egypt Public Health Assoc. 2005;80(3):4.

    Google Scholar 

  110. Piekkola S, Turner P, Abdel-Hamid M, Ezzat S, El-Daly M, El-Kafrawy S, et al. Characterisation of aflatoxin and deoxynivalenol exposure among pregnant Egyptian women. Food Addit Contam A. 2012;29(6):962–71.

    Article  CAS  Google Scholar 

  111. Abdel-Wahab M, Mostafa M, Sabry M, El-Farrash M, Yousef T. Aflatoxins as a risk factor for hepatocellular carcinoma in Egypt, Mansoura Gastroenterology Center study. Hepatogastroenterology. 2008;55(86–87):1754.

    CAS  PubMed  Google Scholar 

  112. Saad-Hussein A, Taha MM, Beshir S, Shahy EM, Shaheen W, Elhamshary M. Carcinogenic effects of aflatoxin B1 among wheat handlers. Int J Occup Environ Health. 2014;20(3):215–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  113. Taghizadeh SF, Rezaee R, Davarynejad G, Asili J, Nemati SH, Goumenou M, et al. Risk assessment of exposure to aflatoxin B1 and ochratoxin A through consumption of different Pistachio (Pistacia vera L.) cultivars collected from four geographical regions of Iran. Environ Toxicol Pharmacol. 2018;61:61–6.

    Article  CAS  PubMed  Google Scholar 

  114. Habibipour R, Tamandegani PR, Farmany A. Monitoring of aflatoxin G1, B1, G2, and B2 occurrence in some samples of walnut. Environ Monit Assess. 2016;188(12):669.

    Article  PubMed  CAS  Google Scholar 

  115. Cheraghali A, Yazdanpanah H, Doraki N, Abouhossain G, Hassibi M, Ali-Abadi S, et al. Incidence of aflatoxins in Iran pistachio nuts. Food Chem Toxicol. 2007;45(5):812–6.

    Article  CAS  PubMed  Google Scholar 

  116. Nejad MI, Farahani A. Aflatoxin in raw walnut kernels marketed in Tehran, Iran. Food Addit Contam B. 2012;5(1):8–10.

    Article  CAS  Google Scholar 

  117. Feizy J, Beheshti H, Fakoor Janati S, Khoshbakht FN. Survey of aflatoxins in watermelon seeds from Iran using immunoaffinity column cleanup and HPLC with fluorescence detection. Food Addit Contam B. 2011;4(2):106–9.

    Article  CAS  Google Scholar 

  118. Janati SSF, Beheshti HR, Fahim NK, Feizy J. Aflatoxins and ochratoxinin A in bean from Iran. Bull Environ Contam Toxicol. 2011;87(2):194–7.

    Article  CAS  Google Scholar 

  119. Nazari F, Sulyok M, Yazdanpanah H, Kobarfard F, Krska R. A survey of mycotoxins in domestic rice in Iran by liquid chromatography tandem mass spectrometry. Toxicol Mech Methods. 2014;24(1):37–41.

    Article  CAS  PubMed  Google Scholar 

  120. Janati SSF, Beheshti HR, Asadi M, Mihanparast S, Feizy J. Preliminary survey of aflatoxins and ochratoxin A in dried fruits from Iran. Bull Environ Contam Toxicol. 2012;88(3):391–5.

    Article  CAS  PubMed  Google Scholar 

  121. Amirkhizi B, Arefhosseini SR, Ansarin M, Nemati M. Aflatoxin B1 in eggs and chicken livers by dispersive liquid–liquid microextraction and HPLC. Food Addit Contam B. 2015;8(4):245–9.

    CAS  Google Scholar 

  122. Ivastava V Sr, Bu-Abbas A, Al-Johar W, Al-Mufti S, Siddiqui M. Aflatoxin M 1 contamination in commercial samples of milk and dairy products in Kuwait. Food Addit Contam. 2001;18(11):993–7.

    Article  Google Scholar 

  123. Abdulkadar A, Al-Ali A, Al-Jedah JH. Occurrence of aflatoxin in commodities imported into Qatar, 1997–2000. Food Addit Contam. 2002;19(7):666–70.

    Article  CAS  PubMed  Google Scholar 

  124. Ul Hassan Z, Al Thani R, Atia FA, Al Meer S, Migheli Q, Jaoua S. Co-occurrence of mycotoxins in commercial formula milk and cereal-based baby food on the Qatar market. Food Addit Contam B. 2018;11(3):191–7.

    Article  CAS  Google Scholar 

  125. Al Jabir M, Barcaru A, Latiff A, Jaganjac M, Ramadan G, Horvatovich P. Dietary exposure of the Qatari population to food mycotoxins and reflections on the regulation limits. Toxicol Rep. 2019;6:975–82.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  126. Saad-Hussein A, Taha M, Fadl N, Awad A, Mahdy-Abdallah H, Moubarz G, et al. Effects of airborne Aspergillus on serum aflatoxin B1 and liver enzymes in workers handling wheat flour. Hum Exp Toxicol. 2016;35(1):3–9.

    Article  CAS  PubMed  Google Scholar 

  127. Abdulrazzaq YM, Osman N, Ibrahim A. Fetal exposure to aflatoxins in the United Arab Emirates. Ann Trop Paediatr. 2002;22(1):3–9.

    Article  PubMed  Google Scholar 

  128. Baydar T, Engin AB, Girgin G, Aydin S, Sahin G. Aflatoxin and ochratoxin in various types of commonly consumed retail ground samples in Ankara, Turkey. Ann Agric Environ Med. 2005;12(2):193–7.

    CAS  PubMed  Google Scholar 

  129. Boyacioglu D, Gönül M. Survey of aflatoxin contamination of dried figs grown in Turkey in 1986. Food Addit Contam. 1990;7(2):235–7.

    Article  CAS  PubMed  Google Scholar 

  130. Kabak B. Aflatoxins in hazelnuts and dried figs: occurrence and exposure assessment. Food Chem. 2016;211:8–16.

    Article  CAS  PubMed  Google Scholar 

  131. Hacıbekiroğlu I, Kolak U. Aflatoxins in various food from Istanbul, Turkey. Food Addit Contam B. 2013;6(4):260–4.

    Article  CAS  Google Scholar 

  132. Kilic S, Cam IB, Tongur T, Kilic M. Health risk assessment of exposure to heavy metals and aflatoxins via dietary intake of dried red pepper from marketplaces in Antalya, Southern Turkey. J Food Sci. 2018;83(10):2675–81.

    Article  CAS  PubMed  Google Scholar 

  133. Colak H, Hampikyan H, Bingol EB, Cetin O, Akhan M, Turgay SI. Determination of mould and aflatoxin contamination in tarhana, a Turkish fermented food. Sci World J. 2012;2012

    Google Scholar 

  134. Özkan A, Bindak R, Erkmen O. Aflatoxin B1 and aflatoxins in ground red chilli pepper after drying. Food Addit Contam B. 2015;8(3):227–33.

    Article  CAS  Google Scholar 

  135. Tosun H, Arslan R. Determination of aflatoxin B1 levels in organic spices and herbs. Sci World J. 2013;2013

    Google Scholar 

  136. Set E, Erkmen O. The aflatoxin contamination of ground red pepper and pistachio nuts sold in Turkey. Food Chem Toxicol. 2010;48(8–9):2532–7.

    Article  CAS  PubMed  Google Scholar 

  137. Karaaslan M, Arslanğray Y. Aflatoxins B 1, B 2, G 1, and G 2 contamination in ground red peppers commercialized in Sanliurfa, Turkey. Environ Monit Assess. 2015;187(4):184.

    Article  PubMed  CAS  Google Scholar 

  138. Günsen U, Büyükyörük I. Aflatoxins in retail food products in Bursa, Turkey. Vet Hum Toxicol. 2002;44(5):289–90.

    PubMed  Google Scholar 

  139. Baydar T, Erkekoglu P, Sipahi H, Sahin G. Aflatoxin B~ 1, M~ 1 and ochratoxin A levels in infant formulae and baby foods marketed in Ankara, Turkey. J Food Drug Anal. 2007;15(1):89.

    CAS  Google Scholar 

  140. Ulca P, Evcimen M, Senyuva H. Surveys of aflatoxin B1 contamination of retail Turkish foods and of products intended for export between 2007 and 2009. Food Addit Contam B. 2010;3(2):120–5.

    Article  CAS  Google Scholar 

  141. Oruc H, Sonal S. Determination of aflatoxin M1 levels in cheese and milk consumed in Bursa, Turkey. Vet Human Toxicol. 2001;43(5):292–3.

    CAS  Google Scholar 

  142. Gürbay A, Sabuncuoğlu SA, Girgin G, Şahin G, Yiğit Ş, Yurdakök M, et al. Exposure of newborns to aflatoxin M1 and B1 from mothers’ breast milk in Ankara, Turkey. Food Chem Toxicol. 2010;48(1):314–9.

    Article  PubMed  CAS  Google Scholar 

  143. Aydin S, Sabuncuoglu S, Erkekoglu P, Şahin G, Giray BK. Serum aflatoxin levels of the healthy adult population living in the north and south regions of Turkey. Public Health Nutr. 2014;17(11):2496–504.

    Article  PubMed  Google Scholar 

  144. Sabuncuoglu S, Erkekoglu P, Aydin S, Şahin G, Kocer-Gumusel B. The effects of season and gender on the serum aflatoxins and ochratoxin A levels of healthy adult subjects from the Central Anatolia Region, Turkey. Eur J Nutr. 2015;54(4):629–38.

    Article  CAS  PubMed  Google Scholar 

  145. Aydın M, Aydın S, Bacanlı M, Başaran N. Aflatoxin levels in chronic hepatitis B patients with cirrhosis or hepatocellular carcinoma in B alıkesir, T urkey. J Viral Hepat. 2015;22(11):926–35.

    Article  PubMed  CAS  Google Scholar 

  146. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  147. Vandercammen G, Seifarth K. New EU Aflatoxin levels and sampling plan. USDA foreign agricultural service Global agricultural information network Gain report. 2010 (E50018).

    Google Scholar 

  148. Candlish A, Pearson S, Aidoo K, Smith J, Kell B, Irvine H. A survey o f ethnic foods for microbial quality and aflatoxin content. Food Addit Contam. 2001;18:129–36.

    Article  CAS  PubMed  Google Scholar 

  149. The Regulation Stating a Change in the Regulation of the Turkish Food Codex.

    Google Scholar 

  150. Williams JH, Phillips TD, Jolly PE, Stiles JK, Jolly CM, Aggarwal D. Human aflatoxicosis in developing countries: a review of toxicology, exposure, potential health consequences, and interventions. Am J Clin Nutr. 2004;80(5):1106–22.

    Article  CAS  PubMed  Google Scholar 

  151. Strosnider H, Azziz-Baumgartner E, Banziger M, Bhat RV, Breiman R, Brune M-N, et al. Workgroup report: public health strategies for reducing aflatoxin exposure in developing countries. Environ Health Perspect. 2006;114(12):1898–903.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  152. Shephard GS. Impact of mycotoxins on human health in developing countries. Food Addit Contam. 2008;25(2):146–51.

    Article  CAS  Google Scholar 

  153. Available from: https://aflasafe.com/wp-content/uploads/pdf/TPP-8-Aflatoxin-Standards-for-Food.pdf.

  154. Allain J-P, Opare-Sem O. Screening and diagnosis of HBV in low-income and middle-income countries. Nat Rev Gastroenterol Hepatol. 2016;13(11):643–53.

    Article  PubMed  Google Scholar 

  155. Fallahian F, Najafi A. Epidemiology of hepatitis C in the Middle East. Saudi J Kidney Dis Transpl. 2011;22(1):1.

    PubMed  Google Scholar 

  156. Toukan AU, Al-Kandari S. The role of hepatitis D virus in liver disease in the Middle East. Prog Clin Biol Res. 1991;364:63–8.

    CAS  PubMed  Google Scholar 

  157. Cancer IAfRo. Alcohol drinking. IARC Monogr Eval Carcinog Risks Hum. 1988;44

    Google Scholar 

  158. Chuang S-C, Lee Y-CA, Wu G-J, Straif K, Hashibe M. Alcohol consumption and liver cancer risk: a meta-analysis. Cancer Causes Control. 2015;26(9):1205–31.

    Article  PubMed  Google Scholar 

  159. Cederbaum AI. Alcohol metabolism. Clin Liver Dis. 2012;16(4):667–85.

    Article  PubMed  PubMed Central  Google Scholar 

  160. Zakhari S. Overview: how is alcohol metabolized by the body? Alcohol Res Health. 2006;29(4):245.

    PubMed  PubMed Central  Google Scholar 

  161. Ogunwobi OO, Harricharran T, Huaman J, Galuza A, Odumuwagun O, Tan Y, et al. Mechanisms of hepatocellular carcinoma progression. World J Gastroenterol. 2019;25(19):2279.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  162. Wang Z, Li Z, Ye Y, Xie L, Li W. Oxidative stress and liver cancer: etiology and therapeutic targets. Oxidative Med Cell Longev. 2016;2016

    Google Scholar 

  163. Ceni E, Mello T, Galli A. Pathogenesis of alcoholic liver disease: role of oxidative metabolism. World J Gastroenterol: WJG. 2014;20(47):17756.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  164. Baraona E, Lieber CS. Effects of ethanol on lipid metabolism. J Lipid Res. 1979;20(3):289–315.

    Article  CAS  PubMed  Google Scholar 

  165. Kourkoumpetis T, Sood G. Pathogenesis of alcoholic liver disease: an update. Clin Liver Dis. 2019;23(1):71–80.

    Article  PubMed  Google Scholar 

  166. Testino G. The burden of cancer attributable to alcohol consumption. Maedica. 2011;6(4):313.

    PubMed  PubMed Central  Google Scholar 

  167. Cancer IAfRo. Personal habits and indoor combustions: a review of human carcinogens. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Part E):1–598.

    Google Scholar 

  168. Stickel F, Schuppan D, Hahn E, Seitz H. Cocarcinogenic effects of alcohol in hepatocarcinogenesis. Gut. 2002;51(1):132–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  169. Singal AK, Anand BS. Mechanisms of synergy between alcohol and hepatitis C virus. J Clin Gastroenterol. 2007;41(8):761–72.

    Article  PubMed  Google Scholar 

  170. Seitz HK, Matsuzaki S, Yokoyama A, Homann N, Väkeväinen S, Wang XD. Alcohol and cancer. Alcohol Clin Exp Res. 2001;25:137S–43S.

    Article  CAS  PubMed  Google Scholar 

  171. WHO Substance Abuse Publications. Turkey. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/tur.pdf?ua=1.

  172. WHO Substance Abuse Publications. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_3.pdf?ua=1WHO.

  173. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/are.pdf?ua=1.

  174. WHO Substance Abuse Publications. Lebanon. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/lbn.pdf?ua=1.

  175. WHO Substance Abuse Publications. Sudan. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/2011/sdn.pdf?ua=1.

  176. WHO Substance Abuse Publications. Israel. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/isr.pdf?ua=1.

  177. WHO Substance Abuse Publications. Kuwait. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/kwt.pdf?ua=1.

  178. WHO Substance Abuse Publications. Qatar. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/qat.pdf?ua=1.

  179. WHO Substance Abuse Publications. Libya. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/lby.pdf?ua=1.

  180. WHO Substance Abuse Publications. Oman. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/omn.pdf?ua=1.

  181. WHO Substance Abuse Publications. Egypt. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/egy.pdf?ua=1.

  182. WHO Substance Abuse Publications. Jordan. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/jor.pdf?ua=1.

  183. WHO Substance Abuse Publications. Saudi Arabia. 2016. Available from: http://tdr.who.int/substance_abuse/publications/global_alcohol_report/profiles/sau.pdf.

  184. WHO Substance Abuse Publications. Afghanistan. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/afg.pdf?ua=1.

  185. WHO Substance Abuse Publications. Iraq. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/irq.pdf?ua=1.

  186. WHO Substance Abuse Publications. bahrain. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/bhr.pdf?ua=1.

  187. WHO Substance Abuse Publications. Syria. 2016. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/profiles/syr.pdf?ua=1.

  188. El-Zayadi A-R. Heavy smoking and liver. World J Gastroenterol: WJG. 2006;12(38):6098.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  189. Hoffmann D, Hoffmann I, El-Bayoumy K. The less harmful cigarette: a controversial issue. A tribute to Ernst L. Wynder. Chem Res Toxicol. 2001;14(7):767–90.

    Article  CAS  PubMed  Google Scholar 

  190. Xue J, Yang S, Seng S. Mechanisms of cancer induction by tobacco-specific NNK and NNN. Cancers. 2014;6(2):1138–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  191. Santella RM, Wu H-C. Environmental exposures and hepatocellular carcinoma. J Clin Transl Hepatol. 2013;1(2):138.

    PubMed  PubMed Central  Google Scholar 

  192. Petrick JL, Campbell PT, Koshiol J, Thistle JE, Andreotti G, Beane-Freeman LE, et al. Tobacco, alcohol use and risk of hepatocellular carcinoma and intrahepatic cholangiocarcinoma: the Liver Cancer Pooling Project. Br J Cancer. 2018;118(7):1005–12.

    Article  PubMed  PubMed Central  Google Scholar 

  193. Palmer WC, Patel T. Are common factors involved in the pathogenesis of primary liver cancers? A meta-analysis of risk factors for intrahepatic cholangiocarcinoma. J Hepatol. 2012;57(1):69–76.

    Article  PubMed  PubMed Central  Google Scholar 

  194. Campbell PT, Newton CC, Freedman ND, Koshiol J, Alavanja MC, Freeman LEB, et al. Body mass index, waist circumference, diabetes, and risk of liver cancer for US adults. Cancer Res. 2016;76(20):6076–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  195. Lin L, Yan L, Liu Y, Qu C, Ni J, Li H. The burden and trends of primary liver cancer caused by specific etiologies from 1990 to 2017 at the global, regional, national, age, and sex level results from the global burden of disease study. Liver Cancer. 2017;2020:1–20.

    Google Scholar 

  196. Lee Y-CA, Cohet C, Yang Y-C, Stayner L, Hashibe M, Straif K. Meta-analysis of epidemiologic studies on cigarette smoking and liver cancer. Int J Epidemiol. 2009;38(6):1497–511.

    Article  PubMed  Google Scholar 

  197. World’s Largest Tobacco Use Study Shows Vast Scope of Tobacco Epidemic and Urgent Need for Countries to Act Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids. Available from: https://www.tobaccofreekids.org/press-releases/2012.

  198. Economist Intellegince Unit. Tomorrow’s regular customers? Stamping out tobacco use in the Middle East and Africa. Available from: http://graphics.eiu.com/upload/pfizer_tobacco%20in%20MEA_WEB.pdf.

  199. Tobacco Free İnitiative. Tobacco Control in Turkey. Available from: https://www.who.int/tobacco/about/partners/bloomberg/tur/en/.

  200. Siddiqua A, Dghaim R, Barakat-Haddad C. Sociodemographic predictors of tobacco smoking among expatriate and national adolescents in the United Arab Emirates. Eastern Mediterr Health Journal. 2018;24(3)

    Google Scholar 

  201. Etemadi A, Poustchi H, Chang CM, Blount BC, Calafat AM, Wang L, et al. Urinary biomarkers of carcinogenic exposure among cigarette, waterpipe, and smokeless tobacco users and never users of tobacco in the Golestan cohort study. Cancer Epidemiol Prev Biomarkers. 2019;28(2):337–47.

    Article  CAS  Google Scholar 

  202. Etemadi A, Khademi H, Kamangar F, Freedman ND, Abnet CC, Brennan P, et al. Hazards of cigarettes, smokeless tobacco and waterpipe in a Middle Eastern Population: a Cohort Study of 50 000 individuals from Iran. Tob Control. 2017;26(6):674–82.

    Article  PubMed  Google Scholar 

  203. Charafeddine MA, Olson SH, Mukherji D, Temraz SN, Abou-Alfa GK, Shamseddine AI. Proportion of cancer in a Middle eastern country attributable to established risk factors. BMC Cancer. 2017;17(1):337.

    Article  PubMed  PubMed Central  Google Scholar 

  204. Hussain F, Anjum S, Alrshoud N, Mehmood A, Bazarbashi S, Hussain AN, et al. Trends and patterns of primary hepatic carcinoma in Saudi Arabia. Gulf J Oncolog. 2019;1(31):41–51.

    PubMed  Google Scholar 

  205. Hashempour-Baltork F, Hosseini H, Houshiarrad A, Esmaeili M. Contamination of foods with arsenic and mercury in Iran: a comprehensive review. Environ Sci Pollut Res. 2019:1–15.

    Google Scholar 

  206. Bhattacharya P, Jacks G, Ahmed K, Routh J, Khan A. Arsenic in groundwater of the Bengal Delta Plain aquifers in Bangladesh. Bull Environ Contam Toxicol. 2002;69(4):538–45.

    Article  CAS  PubMed  Google Scholar 

  207. Ratnaike RN. Acute and chronic arsenic toxicity. Postgrad Med J. 2003;79(933):391–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  208. Tapio S, Schofield P, Adelmann C, Atkinson M, Bard J, Bijwaard H, et al. Grosche B. Arsenic in the aetiology of cancer. Mutat Res. 2006;612:215–46.

    Article  CAS  PubMed  Google Scholar 

  209. Humans IWGotEoCRt, Organization WH, Cancer IAfRo. Some drinking-water disinfectants and contaminants, including arsenic: IARC; 2004.

    Google Scholar 

  210. Gunduz O, Bakar C, Simsek C, Baba A, Elci A, Gurleyuk H, et al. Statistical analysis of causes of death (2005–2010) in villages of Simav Plain, Turkey, with high arsenic levels in drinking water supplies. Arch Environ Occup Health. 2015;70(1):35–46.

    Article  PubMed  Google Scholar 

  211. Yorifuji T, Tsuda T, Doi H, Grandjean P. Cancer excess after arsenic exposure from contaminated milk powder. Environ Health Prev Med. 2011;16(3):164–70.

    Article  CAS  PubMed  Google Scholar 

  212. Fakhri Y, Bjørklund G, Bandpei AM, Chirumbolo S, Keramati H, Pouya RH, et al. Concentrations of arsenic and lead in rice (Oryza sativa L.) in Iran: a systematic review and carcinogenic risk assessment. Food Chem Toxicol. 2018;113:267–77.

    Article  CAS  PubMed  Google Scholar 

  213. Saadatzadeh A, Afzalan S, Zadehdabagh R, Tishezan L, Najafi N, Seyedtabib M, et al. Determination of heavy metals (lead, cadmium, arsenic, and mercury) in authorized and unauthorized cosmetics. Cutan Ocul Toxicol. 2019;38(3):207–11.

    Article  CAS  PubMed  Google Scholar 

  214. Lu S-N, Chow N-H, Wu W-C, Chang T-T, Huang W-S, Chen S-C, et al. Characteristics of hepatocellular carcinoma in a high arsenicism area in Taiwan: a case–control study. J Occup Environ Med. 2004;46(5):437–41.

    Article  CAS  PubMed  Google Scholar 

  215. George CM, Sima L, Arias M, Mihalic J, Cabrera LZ, Danz D, et al. Arsenic exposure in drinking water: an unrecognized health threat in Peru. Bull World Health Organ. 2014;92:565–72.

    Article  PubMed  PubMed Central  Google Scholar 

  216. Alidadi H, Sany SBT, Oftadeh BZG, Mohamad T, Shamszade H, Fakhari M. Health risk assessments of arsenic and toxic heavy metal exposure in drinking water in Northeast Iran. Environ Health Prev Med. 2019;24(1):59.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  217. Available from: https://sites.nicholas.duke.edu/avnervengosh/research/water-and-health/.

  218. Al-Farraj AS, Al-Wabel MI, El-Saeid MH, El-Naggar AH, Ahmed Z. Evaluation of groundwater for arsenic contamination using hydrogeochemical properties and multivariate statistical methods in Saudi Arabia. J Chem. 2013;2013

    Google Scholar 

  219. Toor I, Tahir S. Study of arsenic concentration levels in Pakistani drinking water. Polish J Environ Stud. 2009;18(5)

    Google Scholar 

  220. Gennaro V, Ceppi M, Crosignani P, Montanaro F. Reanalysis of updated mortality among vinyl and polyvinyl chloride workers: confirmation of historical evidence and new findings. BMC Public Health. 2008;8(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

  221. Groopman JD. Environmental carcinogens and risk for human liver cancer. Hepatocellular carcinoma. Springer; 2016. p. 25–41.

    Google Scholar 

  222. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. 1, 3-butadiene, ethylene oxide and vinyl halides (vinyl fluoride, vinyl chloride and vinyl bromide), vol. 97. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans; 2008. p. 3.

    Google Scholar 

  223. Aryanpur J. Vinyl chloride: its impact on occupational medicine practice in Iran. J Occupat Med. 1977;19(10):689–92.

    Article  CAS  Google Scholar 

  224. Ramadan A. Assessment of spatial variation of ambient volatile organic compound levels at a power station in Kuwait. J Air Waste Manage Assoc. 2017;67(11):1170–9.

    Article  CAS  Google Scholar 

  225. Ledda C, Loreto C, Zammit C, Marconi A, Fago L, Matera S, et al. Non-infective occupational risk factors for hepatocellular carcinoma: a review. Mol Med Rep. 2017;15(2):511–33.

    Article  CAS  PubMed  Google Scholar 

  226. Wahlang B, Jin J, Beier JI, Hardesty JE, Daly EF, Schnegelberger RD, et al. Mechanisms of environmental contributions to fatty liver disease. Curr Environ Health Rep. 2019;6(3):80–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Toxicology, Faculty of Pharmacy, Hacettepe University, Ankara, Turkey

    Pinar Erkekoglu & Suna Sabuncuoğlu

Authors
  1. Pinar Erkekoglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suna Sabuncuoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pinar Erkekoglu .

Editor information

Editors and Affiliations

  1. Translational HCC Research, Liver Transplantation Institute, Inonu University, Malatya, Turkey

    Brian I. Carr

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Erkekoglu, P., Sabuncuoğlu, S. (2021). Hepatocarcinogenesis Induced by Environmental Exposures in the Middle East. In: Carr, B.I. (eds) Liver Cancer in the Middle East. Springer, Cham. https://doi.org/10.1007/978-3-030-78737-0_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-78737-0_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78736-3

  • Online ISBN: 978-3-030-78737-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation