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AIM To explore the relationship between the level of aflatoxin-human serum albumin adducts and polymorphisms of glutathione S-transferase (GST) M1 and T1 and primary liver cancer (PLC).METHODS AFT-albumin adducts were measured by sandwich enzyme-linked immunosorbent assay (ELISA) and genotypes of GST M1 and T1 were determined by PCR.RESULTS Compared with those with non-null genotype of both GST T1 and M1, the odds ratio of developing PLC for those with null genotype of both GST T1 and M1 was 3.11 (95% confidence interval: 1.01-9.98; P=0.029). There was a dose-response relationship between serum level of AFT-albumin adducts and risk of PLC (χ2trend=15.42, P=0.0001). By combined genotype of GST T1 and M1, persons with null genotype of GST T1 and M1 were more likely to have higher AFT-albumin adduct level than those with other genotypes of GST T1 and M1 (F=4.57, P＜0.005). The biological gradients between serum AFT-albumin adducts level and PLC risk were observed to determine whether the persons were of null genotype of GST T1 or M1 or not. The levels of AFT-albumin adduct in Haimen residents in 1992 and 1996 were decreased significantly as against 1987 (F=6.35, P＜0.005).CONCLUSION Exposure to aflatoxin may still be one of risk factors leading to PLC endemic in Haimen population and those with null genotype of GST T1 and M1 may be at greater risk of developing PLC once they are exposed to aflatoxin.