Occupational exposure to aflatoxins and health outcomes: a review.

Aflatoxins [AFs] are secondary metabolites of the fungus species Aspergillus spp. Both animal and epidemiological studies provided sufficient evidence on the carcinogenic, immunotoxic, mutagenic, and genotoxic potential of AFs. While ingestion is the main route of exposure for AFs through consumption of contaminated food products, agricultural workers and personnel who handle AF-contaminated grains are also at higher risk of exposure via inhalation. The main objective of the review is to provide a comprehensive overview of past scientific studies on occupational exposure to AFs, high-risk occupations, and disease outcomes. A search of peer-reviewed articles was done on PubMed and Web of Science Databases. A total of 164 papers was identified and 61 journal articles were selected for further review. High risk occupations include animal husbandry and processing of grain cereals and/or animal feed. Primary liver cancer and respiratory cancers were the most reported as a result of occupational exposure to AFs. For future studies, improved study designs, better characterization of AFs exposure in an occupational setting, and use of biomarkers are recommended in order to promote better understanding of occupational exposure to AFs and the resulting disease burden among workers.