Lifetime exposure to arsenic in drinking water and bladder cancer: a population-based case–control study in Michigan, USA (original) (raw)
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Journal of Occupational and Environmental Medicine, 2004
This study analyzes the relationship between arsenic exposure through drinking water and bladder cancer mortality. The county-specific white male bladder cancer mortality data (1950 -1979) and county-specific groundwater arsenic concentration data were obtained for 133 U.S. counties known to be exclusively dependent on groundwater for their public drinking water supply. No arsenic-related increase in bladder cancer mortality was found over the exposure range of 3 to 60 g/L using stratified analysis and regression analyses (both unweighted and weighted by county population and using both mean and median arsenic concentrations). These results, which provide a direct estimate of arsenic-related cancer risk for U.S. residents, exclude the National Research Council's 2001 risk estimate that was based on Southwest Taiwan data and required adjusting for differences between the body mass and water consumption rates of
Journal of Occupational and Environmental Medicine, 2004
This study analyzes the relationship between arsenic exposure through drinking water and bladder cancer mortality. The county-specific white male bladder cancer mortality data (1950 -1979) and county-specific groundwater arsenic concentration data were obtained for 133 U.S. counties known to be exclusively dependent on groundwater for their public drinking water supply. No arsenic-related increase in bladder cancer mortality was found over the exposure range of 3 to 60 g/L using stratified analysis and regression analyses (both unweighted and weighted by county population and using both mean and median arsenic concentrations). These results, which provide a direct estimate of arsenic-related cancer risk for U.S. residents, exclude the National Research Council's 2001 risk estimate that was based on Southwest Taiwan data and required adjusting for differences between the body mass and water consumption rates of
Case-Control Study of Bladder Cancer and Drinking Water Arsenic in the Western United States
American Journal of Epidemiology, 2003
Numerous epidemiologic investigations have identified links between high concentrations of arsenic in drinking water and cancer, although the risks at lower exposures are largely unknown. This paper presents the results of a case-control study of arsenic ingestion and bladder cancer in seven counties in the western United States. These counties contain the largest populations historically exposed to drinking water arsenic at concentrations near 100 µg/liter. All incident cases diagnosed from 1994 to 2000 were recruited. Individual data on water sources, water consumption patterns, smoking, and other factors were collected for 181 cases and 328 controls. Overall, no increased risks were identified for arsenic intakes greater than 80 µg/day (odds ratio = 0.94, 95% confidence interval: 0.56, 1.57; linear trend, p = 0.48). These risks are below predictions based on high dose studies from Taiwan. When the analysis was focused on exposures 40 or more years ago, an odds ratio of 3.67 (95% confidence interval: 1.43, 9.42; linear trend, p < 0.01) was identified for intakes greater than 80 µg/day (median intake, 177 µg/day) in smokers. These data provide some evidence that smokers who ingest arsenic at concentrations near 200 µg/day may be at increased risk of bladder cancer.
This study analyzes the relationship between arsenic exposure through drinking water and bladder cancer mortality. The county-specific white male bladder cancer mortality data (1950 -1979) and county-specific groundwater arsenic concentration data were obtained for 133 U.S. counties known to be exclusively dependent on groundwater for their public drinking water supply. No arsenic-related increase in bladder cancer mortality was found over the exposure range of 3 to 60 g/L using stratified analysis and regression analyses (both unweighted and weighted by county population and using both mean and median arsenic concentrations). These results, which provide a direct estimate of arsenic-related cancer risk for U.S. residents, exclude the National Research Council's 2001 risk estimate that was based on Southwest Taiwan data and required adjusting for differences between the body mass and water consumption rates of
Arsenic in drinking water and bladder cancer: review of epidemiological evidence
2007
Worldwide, an estimated 261 000 cases of urinary bladder cancer are diagnosed, and result in 115 000 deaths each year. Strong evidence exists for an association between bladder cancer and exposure to arsenic (As) in drinking water at concentrations exceeding 300-500 mg/l; however, health risks from As exposure in the 10-100 mg/l range are equivocal. Given low-to-moderate concentrations of As in drinking water, other sources of As exposure such as food, occupational hazards, and tobacco may be important. Exposure to other potential bladder carcinogens in drinking water, such as disinfection byproducts or nitrates, along with mediating factors in the diet, such as selenium and zinc, may also prove to be decisive factors. This review presents a critical evaluation of epidemiologic studies of As in drinking water and bladder cancer, emphasizing the need to carefully assess individual-level exposure to As in drinking water along with other sources of As, as well as considering potential confounding and mediating factors.
Environmental Geochemistry and Health, 2000
Associations between arsenic in drinking water and bladder cancer in an area along the southwest coast of Taiwan have been documented for decades. Several ecologic studies were conducted to assess the dose-response relationships. Some of them used the National Cancer Registry Program to identify cancer cases, and some used death certificates. Whereas the cancer registry collects information on all patients no matter if they died of bladder cancer or not, the case ascertainment might be incomplete due to the fact that reporting of cases is not mandatory. Reporting of death, on the other hand, is strictly enforced by law, but patients who did not die of bladder cancer might not be identified. In order to assess the problems with both approaches, we conducted a study using both case identification mechanisms. A total of 243 townships with measurements of arsenic in drinking water were included in the analysis of cancer registry data, and death certificates were collected from 10 of those townships. In both analyses, the same measurements of arsenic made by the mercuric bromide stain method were adopted. Due to limitation of the method, all levels below 0.04 mg L −1 were combined as a single exposure category. The results were very much alike; both approaches detected statistically significant associations between high arsenic levels in drinking water (above 0.64 mg L −1 ) and occurrence of bladder cancer but did not find such associations for arsenic exposures at lower levels.
Bladder cancer and arsenic through drinking water: A systematic review of epidemiologic evidence
Exposure to inorganic arsenic (As) through drinking water is a major international public health issue. We carried out a systematic review of the existing literature examining the association between the risk of bladder cancer in humans and exposure to arsenic through drinking water. We searched electronic databases for studies published from January 2000 up to April 2013. Eight ecological studies, six case-control studies, four cohort studies and two meta-analyses were identified. The vast majority of the studies were carried out in areas with high arsenic concentrations in drinking water such as southwestern and northeastern Taiwan, Pakistan, Bangladesh, Argentina (Cordoba Province), USA (southeastern Michigan, Florida, Idaho) and Chile. Most of the studies reported higher risks of bladder cancer incidence or mortality in areas with high arsenic concentrations in drinking water compared to the general population or a low arsenic exposed control group. The quality assessment showed that among the studies identified, arsenic exposure was assessed at the individual level only in half of them and only three assessed exposure using a biomarker. Further, five out of eight ecological studies presented results with adjustment for potential confounders except for age; all cohort and case-control studies presented results with adjustment for cigarette smoking status in the analysis. The majority of the studies with varying study designs carried out in different areas provided evidence of statistically siginificant increases in bladder cancer risk at high concentrations of arsenic (>50 µg L −1 ). Assessing bladder cancer risk at lower exposure concentrations requires further investigation.
Elevated Bladder Cancer in Northern New England: The Role of Drinking Water and Arsenic
Journal of the National Cancer Institute, 2016
Bladder cancer mortality rates have been elevated in northern New England for at least five decades. Incidence rates in Maine, New Hampshire, and Vermont are about 20% higher than the United States overall. We explored reasons for this excess, focusing on arsenic in drinking water from private wells, which are particularly prevalent in the region. In a population-based case-control study in these three states, 1213 bladder cancer case patients and 1418 control subjects provided information on suspected risk factors. Log transformed arsenic concentrations were estimated by linear regression based on measurements in water samples from current and past homes. All statistical tests were two-sided. Bladder cancer risk increased with increasing water intake (Ptrend = .003). This trend was statistically significant among participants with a history of private well use (Ptrend = .01). Among private well users, this trend was apparent if well water was derived exclusively from shallow dug we...
Cancer Risks from Arsenic in Drinking Water
Environmental Health Perspectives, 1992
Ingestion ofarsenic, both from water supplies and medicinal preparations, is known tocause skin cancer. The evidence assessed here indicates that arsenic can also cause liver, lung, kidney, and bladder cancer and that the population cancer risks due to arsenic in U.S. water supplies may be comparable to those from environmental tobacco smoke and radon in homes. Large population studies in an area ofTaiwan with high arsenic levels in well water (170-800 jAg/L) were used to establish dose-response relationships between cancer risks and the concentration of inorganic arsenic naturally present in water supplies. It was estimated that at the current EPA standard of50 ug/L, the lifetime risk ofdying from cancer of the liver, lung, kidney, or bladder from drinking 1 L/day of water could be as high as 13 per 1000 persons. It has been estimated that more than 350,000 people in the United States may be supplied with water containing more than 50 yg/L arsenic, and more than 2.5 million people may be supplied with water with levels above 25 Ag/L. For average arsenic levels and waterconsumption patterns in the United States, the risk estimate was around 1/1000. Although further researh is needed to validate these findings, measures to reduce arsenic levels in water supplies should be considered.