Aflatoxins are potent liver carcinogens that frequently contaminate cereals in developing countries. Aflatoxin exposure has been predicted in Egypt but, to date, no studies have measured the level of aflatoxin-albumin (AF-alb) adducts as a validated biomarker to assess exposure. In this pilot survey, a limited number of sera samples, available from a hepatocellular carcinoma (HCC) case-control study in Egypt, were analysed. AF-alb was detected in 24/24 samples from HCC-negative individuals (geometric mean 9.0 pg mg(-1); range 3.5-25.8pg mg(-1)), while 7/22 samples from HCC-positive cases had detectable AF-alb (geometric mean 2.6 pg mg(-1); range: non-detectable-32.8 pg mg(-1)). These AF-alb data do not represent a case-control comparison due to inherent difficulties in comparing markers of dietary intake between controls and patients with disease. Although these data are limited, the potential health consequences of aflatoxin exposure in this region merit further investigation.