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Two of the major risk factors contributing to liver cancer have been well documented by multiple epidemiologic studies and the hepatitis B virus (HBV) and aflatoxin show a synergy that increases by more than 8\u2010fold the risk of liver cancer relative to HBV alone. Using the population\u2010based cancer registry established by the Qidong Liver Cancer Institute in 1972 and aflatoxin\u2010specific biomarkers, we document that reduction of aflatoxin exposure has likely contributed to a nearly 70% decline in age\u2010standardized liver cancer incidence over the past 30\u2009years despite an unchanging prevalence of HBV infection in cases. A natural experiment of economic reform in the 1980s drove a rapid switch from consumption of heavily contaminated corn to minimally, if any, contaminated rice and subsequent dietary diversity. Aflatoxin consumption appears to accelerate the time to liver cancer diagnosis; lowering exposure to this carcinogen adds years of life before a cancer diagnosis. Thus, in 1990 the median age of diagnosis was 48\u2009years, while increasing to 67\u2009years by 2021. These findings have important translational public health implications since up to 5 billion people worldwide might be routinely exposed to dietary aflatoxin, especially in societies using corn as the staple food. Interventions against aflatoxin are an achievable outcome leading to a reduction in liver cancer incidence and years of delay of its nearly always fatal diagnosis.<\/jats:p>","DOI":"10.1002\/ijc.35198","type":"journal-article","created":{"date-parts":[[2024,9,21]],"date-time":"2024-09-21T16:14:11Z","timestamp":1726935251000},"page":"756-763","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Profound primary prevention of liver cancer following a natural experiment in China: A 50\u2010year perspective and public health implications"],"prefix":"10.1002","volume":"156","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4102-8934","authenticated-orcid":false,"given":"Jian\u2010Guo","family":"Chen","sequence":"first","affiliation":[{"name":"Qidong Liver Cancer Institute, Qidong People's Hospital Affiliated Qidong Hospital of Nantong University  Nantong 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