Aristolochic acids (AAs) are a group of naturally occurring compounds present in many plant species of the Aristolochiaceae family. Exposure to AA is a significant risk factor for severe nephropathy, and urological and hepatobiliary cancers (among others) that are often recurrent and characterized by the prominent mutational fingerprint of AA. However, herbal medicinal products that contain AA continue to be manufactured and marketed worldwide with inadequate regulation, and possible environmental exposure routes receive little attention. As the trade of food and dietary supplements becomes increasingly globalized, we propose that further inaction on curtailing AA exposure will have far-reaching negative effects on the disease trends of AA-associated cancers. Our Review aims to systematically present the historical and current evidence for the mutagenicity and carcinogenicity of AA, and the effect of removing sources of AA exposure on cancer incidence trends. We discuss the persisting challenges of assessing the scale of AA-related carcinogenicity, and the obstacles that must be overcome in curbing AA exposure and preventing associated cancers. Overall, this Review aims to strengthen the case for the implementation of prevention measures against AA’s multifaceted, detrimental and potentially fully preventable effects on human cancer development.

马兜铃酸 (AA) 是一组天然存在的化合物，存在于马兜铃科的许多植物物种中。暴露于 AA 是严重肾病、泌尿系统癌症和肝胆系统癌症（以及其他癌症）的重要危险因素，这些癌症通常会复发，并且以 AA 的显着突变指纹为特征。然而，含有 AA 的草药产品继续在世界范围内生产和销售，监管不力，可能的环境暴露途径很少受到关注。随着食品和膳食补充剂贸易日益全球化，我们建议在减少 AA 暴露方面进一步不采取行动将对 AA 相关癌症的疾病趋势产生深远的负面影响。我们的综述旨在系统地介绍 AA 的致突变性和致癌性的历史和当前证据，以及消除 AA 暴露源对癌症发病趋势的影响。我们讨论了评估 AA 相关致癌性规模的持续挑战，以及在遏制 AA 暴露和预防相关癌症方面必须克服的障碍。总体而言，本综述旨在加强针对 AA 对人类癌症发展的多方面、有害和可能完全可预防的影响实施预防措施的理由。以及在抑制 AA 暴露和预防相关癌症方面必须克服的障碍。总体而言，本综述旨在加强针对 AA 对人类癌症发展的多方面、有害和可能完全可预防的影响实施预防措施的理由。以及在抑制 AA 暴露和预防相关癌症方面必须克服的障碍。总体而言，本综述旨在加强针对 AA 对人类癌症发展的多方面、有害和可能完全可预防的影响实施预防措施的理由。