Lin S, Gao K, Gu S, et al. Worldwide trends in cervical cancer incidence and mortality, with predictions for the next 15 years. Cancer. 2021;127:4030–9.
Sung H, Ferlay J, Siegel RL, et al. Global Cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.
Ngwa W, Addai BW, Adewole I, et al. Cancer in sub-Saharan africa: a lancet oncology commission. Lancet Oncol. 2022;23:e251–312.
Google Scholar
Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO global cervical Cancer elimination initiative. Lancet Global Health. 2023;11:e197–206.
Google Scholar
Dzinamarira T, Moyo E, Dzobo M, Mbunge E, Murewanhema G. Cervical cancer in sub-Saharan africa: an urgent call for improving accessibility and use of preventive services. Int J Gynecol Cancer: Official J Int Gynecol Cancer Soc. 2023;33:592–7.
Mboumba Bouassa RS, Prazuck T, Lethu T, Jenabian MA, Meye JF, Belec L. Cervical cancer in sub-Saharan africa: a preventable noncommunicable disease. Expert Rev anti-infective Therapy. 2017;15:613–27.
Google Scholar
Mulongo M, Chibwesha CJ. Prevention of cervical Cancer in Low-Resource African settings. Obstet Gynecol Clin North Am. 2022;49:771–81.
Ramogola-Masire D, Luckett R, Dreyer G. Progress and challenges in human papillomavirus and cervical cancer in Southern Africa. Curr Opin Infect Dis. 2022;35:49–54.
Brower V. AIDS-related cancers increase in Africa. J Natl Cancer Inst. 2011;103:918–9.
Huang J, Deng Y, Boakye D, et al. Global distribution, risk factors, and recent trends for cervical cancer: A worldwide country-level analysis. Gynecol Oncol. 2022;164:85–92.
Franco EL, Rohan TE, Villa LL. Epidemiologic evidence and human papillomavirus infection as a necessary cause of cervical cancer. J Natl Cancer Inst. 1999;91:506–11.
Google Scholar
Walboomers JMM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. 1999;189:12–9.
Google Scholar
Wei F, Georges D, Man I, Baussano I, Clifford GM. Causal attribution of human papillomavirus genotypes to invasive cervical cancer worldwide: a systematic analysis of the global literature. Lancet. 2024;404:435–44.
Google Scholar
Koshiol J, Lindsay L, Pimenta JM, Poole C, Jenkins D, Smith JS. Persistent human papillomavirus infection and cervical neoplasia: A systematic review and Meta-Analysis. Am J Epidemiol 2008.
Stensen S, Kjaer SK, Jensen SM, et al. Factors associated with type-specific persistence of high-risk human papillomavirus infection: A population-based study. Int J cancer J Int Du cancer. 2016;138:361–8.
Google Scholar
Services USDoHaH. Surveillance, Epidemiology, and End Results Program. 2025.
Gilles C, Konopnicki D, Rozenberg S. The recent natural history of human papillomavirus cervical infection in women living with HIV: A scoping review of meta-analyses and systematic reviews and the construction of a hypothetical model. HIV medicine. 2023.
Gong YY, Wilson S, Mwatha JK, et al. Aflatoxin exposure May contribute to chronic hepatomegaly in Kenyan school children. Environ Health Perspect. 2012;120:893–6.
Google Scholar
Seetha A, Monyo ES, Tsusaka TW, et al. Aflatoxin-lysine adducts in blood serum of the Malawian rural population and aflatoxin contamination in foods (groundnuts, maize) in the corresponding areas. Mycotoxin Res. 2018;34:195–204.
Google Scholar
Watson S, Moore SE, Darboe MK, et al. Impaired growth in rural Gambian infants exposed to aflatoxin: a prospective cohort study. BMC Public Health. 2018;18:1247.
Google Scholar
Omara T, Nassazi W, Omute T et al. Aflatoxins in Uganda: An Encyclopedic Review of the Etiology, Epidemiology, Detection, Quantification, Exposure Assessment, Reduction, and Control. Int J Microbiol. 2020; 2020:4723612.
Bennett JW, Klich M, Mycotoxins. Clin Microbiol Rev. 2003;16:497–516.
Google Scholar
Zitomer NC, Awuor AO, Widdowson MA et al. Human aflatoxin exposure in Uganda: Estimates from a subset of the 2011 Uganda AIDS indicator survey (UAIS). Food additives & contaminants Part A, Chemistry, analysis, control, exposure & risk assessment 2021; 38:136– 47.
Kang MS, Nkurunziza P, Muwanika R et al. Longitudinal evaluation of aflatoxin exposure in two cohorts in south-western Uganda. Food additives & contaminants Part A, Chemistry, analysis, control, exposure & risk assessment. 2015; 32:1322-30.
McGlynn KA, Petrick JL, El-Serag HB. Epidemiol Hepatocellular Carcinoma Hepatol. 2021;73(Suppl 1):4–13.
Google Scholar
Madeen EP, Maldarelli F, Groopman JD, Environmental, Pollutants. Mucosal barriers, and pathogen susceptibility; the case for aflatoxin B(1) as a risk factor for HIV transmission and pathogenesis. Pathogens 2021; 10.
Chu YJ, Yang HI, Wu HC, et al. Aflatoxin B1 exposure increases the risk of hepatocellular carcinoma associated with hepatitis C virus infection or alcohol consumption. Eur J Cancer. 2018;94:37–46.
Google Scholar
Rushing BR, Selim MI. Aflatoxin B1: A review on metabolism, toxicity, occurrence in food, occupational exposure, and detoxification methods. Food Chem Toxicol. 2019;124:81–100.
Google Scholar
Wild CP, Gong YY. Mycotoxins and human disease: a largely ignored global health issue. Carcinogenesis. 2010;31:71–82.
Google Scholar
Turner PC, Moore SE, Hall AJ, Prentice AM, Wild CP. Modification of immune function through exposure to dietary aflatoxin in Gambian children. Environ Health Perspect. 2003;111:217–20.
Google Scholar
Meissonnier GM, Pinton P, Laffitte J, et al. Immunotoxicity of aflatoxin B1: impairment of the cell-mediated response to vaccine antigen and modulation of cytokine expression. Toxicol Appl Pharmacol. 2008;231:142–9.
Google Scholar
Jolly PE. Aflatoxin: does it contribute to an increase in HIV viral load? Future Microbiol. 2014;9:121–4.
Google Scholar
Shirani K, Zanjani BR, Mahmoudi M, et al. Immunotoxicity of aflatoxin M1: as a potent suppressor of innate and acquired immune systems in a subacute study. J Sci Food Agric. 2018;98:5884–92.
Google Scholar
Scholl PF, Groopman JD. Synthesis of 5,5,6,6-D4-L-lysine-aflatoxin Bl for use as a mass spectrometric internal standard. J Label Compd Radiopharm. 2004;47:805–15.
Zhang J, Orang’o O, Tonui P et al. Detection and concentration of plasma aflatoxin is associated with detection of oncogenic human papillomavirus in Kenyan women. Open Forum Infect Dis 2019; 6.
Tong Y, Tonui P, Orang’o O, et al. Association of plasma aflatoxin with persistent detection of oncogenic human papillomaviruses in cervical samples from Kenyan women enrolled in a longitudinal study. BMC Infect Dis. 2023;23:377.
Google Scholar
Tong Y, Orang’o E, Nakalembe M, et al. The East Africa consortium for human papillomavirus and cervical cancer in women living with HIV/AIDS. Ann Med. 2022;54:1202–11.
Google Scholar
Tong Y, Tonui P, Ermel A, et al. Persistence of oncogenic and non-oncogenic human papillomavirus is associated with human immunodeficiency virus infection in Kenyan women. SAGE Open Med. 2020;8:2050312120945138.
WHO. Human papillomaviruses. IARC working group on the evaluation of carcinogenic risks to humans. IARC Monogr. 2007;90:1–636.
McCoy LF, Scholl PF, Sutcliffe AE, et al. Human aflatoxin albumin adducts quantitatively compared by ELISA, HPLC with fluorescence detection, and HPLC with isotope Dilution mass spectrometry. Cancer Epidemiol Biomarkers Prev. 2008;17:1653–7.
Google Scholar
Smith JW, Kroker-Lobos MF, Lazo M, et al. Aflatoxin and viral hepatitis exposures in guatemala: molecular biomarkers reveal a unique profile of risk factors in a region of high liver cancer incidence. PLoS ONE. 2017;12:e0189255.
Scholl PF, Groopman JD. Long-term stability of human aflatoxin B1 albumin adducts assessed by isotope Dilution mass spectrometry and high-performance liquid chromatography-fluorescence. Cancer Epidemiol Biomarkers Prev. 2008;17:1436–9.
Google Scholar
McCoy LF, Scholl PF, Schleicher RL, Groopman JD, Powers CD, Pfeiffer CM. Analysis of aflatoxin B1-lysine adduct in serum using isotope-dilution liquid chromatography/tandem mass spectrometry. Rapid Commun Mass Spectrom. 2005;19:2203–10.
Google Scholar
Smith JW, Ng DK, Alvarez CS et al. Assessing the validity of normalizing aflatoxin B(1)-Lysine albumin adduct biomarker measurements to total serum albumin concentration across multiple human population studies. Toxins (Basel) 2022; 14.
Chen JG, Kensler TW, Zhu J, et al. Profound primary prevention of liver cancer following a natural experiment in china: A 50-year perspective and public health implications. Int J cancer J Int Du cancer. 2025;156:756–63.
Google Scholar
Groopman JD, Egner PA, Schulze KJ, et al. Aflatoxin exposure during the first 1000 days of life in rural South Asia assessed by aflatoxin B(1)-lysine albumin biomarkers. Food Chem Toxicol. 2014;74:184–9.
Google Scholar
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;80:1106–22.
Google Scholar
Wagacha JM, Muthomi JW. Mycotoxin problem in africa: current status, implications to food safety and health and possible management strategies. Int J Food Microbiol. 2008;124:1–12.
Google Scholar
Gnonlonfin GJ, Hell K, Adjovi Y, et al. A review on aflatoxin contamination and its implications in the developing world: a sub-Saharan African perspective. Crit Rev Food Sci Nutr. 2013;53:349–65.
Google Scholar
Saha Turna N, Comstock SS, Gangur V, Wu F. Effects of aflatoxin on the immune system: evidence from human and mammalian animal research. Crit Rev Food Sci Nutr. 2024;64:9955–73.
Google Scholar
Carvajal M, Berumen J, Guardado-Estrada M. The presence of aflatoxin B(1)-FAPY adduct and human papilloma virus in cervical smears from cancer patients in Mexico. Food Addit Contaminants Part Chem Anal Control Exposure Risk Assess. 2012;29:258–68.
Google Scholar
Zhang J, Zheng N, Liu J, Li FD, Li SL, Wang JQ. Aflatoxin B1 and aflatoxin M1 induced cytotoxicity and DNA damage in differentiated and undifferentiated Caco-2 cells. Food Chem Toxicol. 2015;83:54–60.
Google Scholar
Coskun E, Jaruga P, Vartanian V et al. Aflatoxin-guanine DNA adducts and Oxidatively-induced DNA damage in Aflatoxin-treated mice in vivo as measured by liquid Chromatography-Tandem mass spectrometry with Isotope-dilution. Chem Res Toxicol 2018.
Engin AB, Engin A. DNA damage checkpoint response to aflatoxin B1. Environ Toxicol Pharmacol. 2019;65:90–6.
Google Scholar
Soni P, Ghufran MS, Olakkaran S, Puttaswamygowda GH, Duddukuri GR, Kanade SR. Epigenetic alterations induced by aflatoxin B1: an in vitro and in vivo approach with emphasis on enhancer of Zeste homologue-2/p21 axis. Sci Total Environ. 2021;762:143175.
Google Scholar
Organization WH. Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020.
Agbetiameh D, Ortega-Beltran A, Awuah RT, Atehnkeng J, Cotty PJ, Bandyopadhyay R. Prevalence of aflatoxin contamination in maize and groundnut in ghana: population structure, distribution, and toxigenicity of the causal agents. Plant Dis. 2018;102:764–72.
Google Scholar
Gachara G, Suleiman R, Kilima B, et al. Pre- and post-harvest aflatoxin contamination and management strategies of Aspergillus spoilage in East African community maize: review of etiology and Climatic susceptibility. Mycotoxin Res. 2024;40:495–517.
Google Scholar
Garcia-Ramon DF, Cornelio-Santiago HP, Norabuena E, et al. Effective novel and conventional technologies for decontamination of aflatoxin B(1) in foods: a review. Mycotoxin Res. 2025;41:301–21.
Gravitt PE. Evidence and impact of human papillomavirus latency. Open Virol J. 2012;6:198–203.
Saeed F, Nadeem M, Ahmed R, Nadeem M, Arshad M, Ullah A. Studying the impact of nutritional immunology underlying the modulation of immune responses by nutritional compounds – a review. Food Agricultural Immunol. 2016;27:205–29.
Google Scholar