Circumstances associated with the contamination of food by aflatoxin in a high primary liver cancer area.

The variable incidence of primary liver cancer has been shown to be related to the average daily intake of aflatoxin in various parts of the world. This study was made to detect and report strategic points of contamination of foodstuffs in the region with the highest known incidence of liver cancer. Methods of food production, harvesting, storage and preparation were examined, and defects which promote fungus growth on food were found at each stage. Most meals consisted of a single dish with three basic ingredients -- a protein, bulk carbohydrate and green vegetables. Groundnuts were the main source of protein, but were also the main cause of aflatoxin contamination, since casual traditional methods of agriculture are not suited to the production of this exotic crop. Aflatoxin production appears to occur in the main sources of carbohydrate, such as cassava and maize, during storage. Leaves of various kinds provide substitutes for green vegetables and common methods of handling the crop promote fungal growth. Western-type foods had a particularly low aflatoxin content, or were free of it. Education and economic opportunities external to the subsistence economy structure are contributing to the westerisation of some living habits, a process believed to be responsible for the observed decrease in the incidence of primary liver cancer. Current knowledge indicates that a pertinent but simple educational programme could further markedly reduce the incidence of the disease.