**7. AFB1 as a cancer agent**

As stated above, humans get exposed to AFB1 when they consume food contaminated with aflatoxins or when they inhale dust particles containing aflatoxins and this could lead to acute or chronic aflatoxicosis. The signs and symptoms of aflatoxicosis include stomach ache, regurgitation, pulmonary congestion, multifocal hepatic necrosis and non-alcoholic fatty pancreatic disease. Again, AFB1 is the major potent

#### *Aflatoxin B1: An Immunomodulator and Cancer Agent DOI: http://dx.doi.org/10.5772/intechopen.106833*

lethal human hepatocarcinogen and is classified as group 1 human carcinogen by the IARC [4] Data from Global Cancer Observatory Report (GLOBOCAN 2020) indicate that the global incidence of cancers in 2020 was roughly 19.3 million with 10 million cancer deaths. Cancer is reported as the leading cause of premature deaths globally [58]. The global rise of the cancers as leading cause of mortality resulted in the decline of both communicable and non-communicable diseases among humans.

HCC is the sixth commonest diagnosed cancer and the third leading cause of cancer mortality globally according to global cancer statistics 2020 report. HCC is more prevalent in resource limited countries. The most important factors that put individuals at risk of developing HCC comprise persistent HBV and HCV infections, AFB1 exposure, excessive intake of alcohol and iron overload [11]. Aflatoxins particularly AFB1 are established risk factors of HCC in humans and animals. In a case–control study to determine the association between aflatoxins and HCC, the authors reported that the average aflatoxin exposure per day in cases of HCC was 4.5 times higher than in the control groups [59]. A similar study in Mozambique directly correlated high dietary intake of aflatoxins to incidence of HCC [60]. Importantly, in the context of AFB1 and HBV infection co-existing, the risk of developing HCC is increased by more than 30 times [61] compared to either HBV or aflatoxin exposure alone.
