Risk estimates of hepatocellular carcinoma in Vojvodina (Serbia) related to aflatoxin M1 contaminated cheese

Abstract Aflatoxin M1 (AFM1) is a well known hazard with potential to induce hepatocellular carcinoma, frequently found in milk and dairy products, including cheese. In order to understand the scale of health burden associated to AFM1 exposure in the population of Vojvodina (Serbia), an investigation of cheese contamination was carried out on 60 samples collected during 2019−2020. Analyses by ELISA and HPLC-FLD methods revealed that as much as 70 % of the samples contained detectable amounts of AFM1 (>25 ng/kg). Notable differences were recorded between domestic and imported samples, regarding AFM1 occurrence (78 vs 58 %) and mean content (97 vs 28 ng/kg). Regarding risk estimates, margins of exposure (MoEs) for AFM1–induced hepatocellular carcinoma were of low health concern (>10,000) for all population groups, across exposure levels, except for preschool children at high exposure (P95: 7148). Exclusive consumption of domestic cheeses resulted in even lower MoEs, indicating risk for preschool children (P95: 3867) and children (P95: 6414). With respect to AFM1-induced additional hepatocellular cancer cases assessed based on combined effects of AFM1 and chronic hepatitis B/C viral infection, even the highest estimates were below the level of concern. Study results should enable policy-makers to set priorities in the national food safety system.