Objective. To examine overall, sex, and state-specific liver cancer mortality trends in Mexico. Materials and meth­ods. Joinpoint regression was used to examine the trends in age-standardized mortality rates of liver cancer between 1998-2018. Estimated annual percent change with 95% confi­dence intervals (95%CI) were computed. Age-period-cohort models were used to assess the effects of age, calendar year, and birth cohort. Results. The state-specific mortality rates ranged from 3.34 (Aguascalientes) to 7.96 (Chiapas) per 100 000 person-years. Sex-specific rates were roughly equal, nationwide. Overall, we observed a statistically significant decrease in liver cancer mortality rates between 1998-2018 (annual percent change, -0.8%; 95%CI -1.0, -0.6). The overall age-period-cohort models suggest that birth cohort may be the most important factor driving the trends. Conclusions. While there was overall decline in liver cancer mortality, differences in rates by region were observed. The regional differences may inform future studies of liver cancer etiology across the country.

Objective. To determine the exposure to aflatoxin B1 (AFB1) in southern Mexico and the presence of the aflatoxin signature mutation in hepatocellular carcinoma (HCC) tissue from patients from a cancer referral center. Materials and methods. We estimated the prevalence and distribution of AFB1 in a representative sample of 100 women and men from Chiapas using the National Health and Nutrition Survey 2018-19. We also examined the presence of the aflatoxin signature mutation in codon 249 (R249S), and other relevant mutations of the TP53 gene in HCC tissue blocks from 24 women and 26 men treated in a national cancer referral center. Results. The prevalence of AFB1 in serum samples was 85.5% (95%CI 72.1-93.1) and the median AFB1 was 0.117 pg/μL (IQR, 0.050–0.350). We detected TP53 R249S in three of the 50 HCCs (6.0%) and observed four other G>T transversions potentially induced by AFB1. Conclusion. Our analysis provides evidence that AFB1 may have a relevant role on HCC etiology in Mexico.

Liver cancer is the fourth leading cause of cancer-related death worldwide. In Mexico, there is a high burden of liver cancer mortality in rural states, which affects both women and men equally. Thus, we aimed to describe the demographic and clinical characteristics of hepatocellular cancer (HCC) by sex in Mexico. Demographic and clinical information were extracted retrospectively from the medical records of patients with HCC initially treated (2015-2022) at participating institutions of a national survey across the country. The male-to-female ratio was calculated at the national and regional levels and the results were stratified by sex. Among 697 HCC patients, the age at diagnosis was 65.4±11.9y and 20% were diagnosed at ≥75y. The male-to-female ratio was 1.4:1, ranging from 1:1 in the northwestern and southwestern regions to 2.1:1 in the western region. The proportion of cirrhosis was similar between sexes; however, the etiologies for cirrhosis differed: cryptogenic cirrhosis was higher in women and alcohol consumption was higher in men. Men had a higher proportion of advanced HCC, poor/undifferentiated tumors, and ≥4 nodules than women. HCC in the Mexican population affects men and women at a 1.4:1 male-to-female ratio. This unique proportion by sex could be explained by the differences in the prevalence of risk factors across our heterogeneous country.