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Research Letter
May 26, 2015

Association of Aflatoxin With Gallbladder Cancer in Chile

Author Affiliations
  • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
  • 2School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
  • 3Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA. 2015;313(20):2075-2077. doi:10.1001/jama.2015.4559

In Chile, gallbladder cancer is a leading cause of cancer death in women. Other than gallstones, gallbladder cancer etiology remains largely unclear. Exposure to aflatoxin, a liver carcinogen, is associated with bile duct epithelium proliferation in both animals and humans,1 and with gallbladder cancer in primates.1 Aflatoxin contamination has been identified in Chile, including in ají rojo (red chili peppers). Ají rojo is associated with gallbladder cancer2; however, the association of aflatoxin with gallbladder cancer in humans has not been directly evaluated.

We evaluated plasma aflatoxin-albumin adducts and gallbladder cancer in a pilot study conducted from April 2012 through August 2013. We recruited incident gallbladder cancer cases identified through rapid ascertainment at cancer referral hospitals in Santiago, Concepción, and Temuco, Chile. We initially recruited all cases consecutively and later recruited only surgical cases to provide tissue samples for future studies. We aimed at 1:1:1 matching by age and sex, as well as hospital for controls with gallstones (to ensure associations with gallbladder cancer were not solely due to gallstones) or study site for community controls. Pairing of controls with gallstones was limited by the small number of patients older than 50 years who underwent gallbladder surgery.