M Ledenko, SO Antwi, T Patel. Hepatology 2024; 79: 575-588. Geospatial analysis of cyanobacterial exposure and liver cancer in the contiguous United States

Cyanobacteria are commonly found in water bodies and their production of hepatotoxins can contribute to liver damage.

Methods: Across the contiguous United States, regions with high cyanobacteria exposure (CE) counts in water bodies were identified using satellite remote sensing data. The data were geospatially mapped to county boundaries, and disease mortality and incidence rates were analyzed.

Key findings:

• There was a highly significant spatial association between CE, liver disease, and liver cancer. In Figure 4, the counties in the top half of CE had higher liver cancer. The mean CE 569.6 in the top half compared with median counts of CE of 319.5 in the bottom half of CE
• Counties with CE exceeding the 80Th percentile for >8 or more years had as significantly higher liver cancer age-adjusted incidence rate (mean 9.48) compared with that did so for 5 or fewer years (mean=8.79)
• Hot spots of CE and mortality were identified along the Gulf of Mexico, eastern Texas, Louisiana, and Florida, and cold spots across the Appalachians. 
• Cyanotoxins were detected in 62% of US counties using remote sensing.

My take: This study shows an association between areas with higher CE exposure and increased risk of liver cancer. This could be mediated via contaminated water exposure.