Long-Term Impact of Arsenic in Drinking Water on Bladder Cancer Health Care and Mortality Rates 20 Years After End of Exposure

Fernández, Mario; López, José Regalado; Vivaldi, B.; Coz, Fernando

doi:10.1016/j.juro.2011.10.157

Cited by 70 publications

(47 citation statements)

References 23 publications

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“…In accordance with the three levels of As exposure examined (< 300; 300 – 590; > 600 μg/L As), age-adjusted cancer mortality rates per 100,000 were as follows: 15.7, 37.8, 89.1 per 100, 000 males and 16.7, 35.1, 91.5 per 100,000 females. While these findings profiled the highly exposed populations of Taiwan, increased mortality from bladder cancer due to As exposure in drinking water was also observed in Argentina [35,36,62,63] and Chile [38,39,55]. For example, compared to un-contaminated areas, males and females from the highly contaminated Region II of Chile, experienced mortality rates due to bladder cancer, 6.0 and 8.2 times greater, respectively [39].…”

Section: Resultsmentioning

confidence: 85%

Arsenic in drinking water and urinary tract cancers: a systematic review of 30 years of epidemiological evidence

et al. 2014

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BackgroundArsenic in drinking water is a public health issue affecting hundreds of millions of people worldwide. This review summarizes 30 years of epidemiological studies on arsenic exposure in drinking water and the risk of bladder or kidney cancer, quantifying these risks using a meta-analytical framework.MethodsForty studies met the selection criteria. Seventeen provided point estimates of arsenic concentrations in drinking water and were used in a meta-analysis of bladder cancer incidence (7 studies) and mortality (10 studies) and kidney cancer mortality (2 studies). Risk estimates for incidence and mortality were analyzed separately using Generalized Linear Models. Predicted risks for bladder cancer incidence were estimated at 10, 50 and 150 μg/L arsenic in drinking water. Bootstrap randomizations were used to assess robustness of effect size.ResultsTwenty-eight studies observed an association between arsenic in drinking water and bladder cancer. Ten studies showed an association with kidney cancer, although of lower magnitude than that for bladder cancer. The meta-analyses showed the predicted risks for bladder cancer incidence were 2.7 [1.2–4.1]; 4.2 [2.1–6.3] and; 5.8 [2.9–8.7] for drinking water arsenic levels of 10, 50, and 150 μg/L, respectively. Bootstrapped randomizations confirmed this increased risk, but, lowering the effect size to 1.4 [0.35–4.0], 2.3 [0.59–6.4], and 3.1 [0.80–8.9]. The latter suggests that with exposures to 50 μg/L, there was an 83% probability for elevated incidence of bladder cancer; and a 74% probability for elevated mortality. For both bladder and kidney cancers, mortality rates at 150 ug/L were about 30% greater than those at 10 μg/L.ConclusionArsenic in drinking water is associated with an increased risk of bladder and kidney cancers, although at lower levels (<150 μg/L), there is uncertainty due to the increased likelihood of exposure misclassification at the lower end of the exposure curve. Meta-analyses suggest exposure to 10 μg/L of arsenic in drinking water may double the risk of bladder cancer, or at the very least, increase it by about 40%. With the large number of people exposed to these arsenic concentrations worldwide the public health consequences of arsenic in drinking water are substantial.

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Section: Resultsmentioning

confidence: 85%

Arsenic in drinking water and urinary tract cancers: a systematic review of 30 years of epidemiological evidence

et al. 2014

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“…Arsenic in drinking water is a risk factor for BC in many parts of the world (Naranmandura et al, 2011). The chances of exposure to arsenic depends on the living conditions, such as whether they receive their drinking water from public and sanitary systems; this possibility is low in accordance with the standards defined by arsenic (Fernández et al, 2012). The findings from a casecontrol study in Main-New Hampshire-Vermont showed that there is a link between low to moderate levels of arsenic in drinking water and the risk of BC; the daily BC rate in these individuals is 20% higher than the United States population ( [Internet], 2017).…”

Section: -Nutritional Factorsmentioning

confidence: 99%

“…Findings of a study in Bangladesh showed that mortality risks doubled after consumption of arsenic-contaminated water (Burger et al, 2013). In a recent Chilean analysis, it was found that after 20 years of discontinuation of arseniccontaminated water use, mortality rates were significantly higher in contaminated areas (Hazard Ratio (HR): 3.6; 95% CI: 3-4.7) (Fernández et al, 2012). The mechanism of BC induction through arsenic is uncertain, but it seems that arsenic increases the risk of BC through indirect inhibition of sulfhydrylcontaining enzymes, interference with cytotoxic metabolism, genotoxicity, and inhibition of enzymes that play an antioxidant role (Tapio and Grosche, 2006).…”

Section: -Nutritional Factorsmentioning

confidence: 99%

Essentials of bladder cancer worldwide: incidence, mortality rate and risk factors

et al. 2017

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Bladder cancer (BC) is the sixth most common cancer in the world. An increase in the incidence and recurrence of BC has led to massive pressure on health care systems. Studies have shown that the geographical and ethical distributions of BC are variable in different parts of the world. However, most studies have focused more on clinical challenges and treatment strategies in BC management. Due to the limited number of studies conducted on the incidence rate, mortality and risk factors of BC worldwide, it is necessary to carry out studies in these areas. Therefore, the aim of this study was to determine the global incidence rate, mortality rate and risk factors for BC.

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“…50 Furthermore, studies from Taiwan and Chile indicate that elevated cancer risk among arsenic exposed populations persists for several decades after cessation of exposure. 3,11,51 Therefore, the association between arsenical skin lesion status and lung cancer mortality may be attributable to skin lesion status either as a proxy for increased susceptibility to arsenic toxicity or as a proxy for past cumulative or peak arsenic exposure.…”

Section: Discussionmentioning

confidence: 99%

Arsenic and Lung Disease Mortality in Bangladeshi Adults

et al. 2014

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Background Chronic arsenic exposure through drinking water is a public health problem affecting millions of people worldwide, including at least 30 million in Bangladesh. We prospectively investigated the associations of arsenic exposure and arsenical skin lesion status with lung disease mortality in Bangladeshi adults. Methods Data are from a population-based sample of 26,043 adults, with an average of 8.5 years of follow-up (220,157 total person-years). There were 156 non-malignant lung disease deaths and 90 lung cancer deaths ascertained through October 2013. We used Cox proportional hazards models to estimate adjusted hazard ratios and 95% confidence intervals (CIs) for lung disease mortality. Results Creatinine-adjusted urinary total arsenic was associated with non-malignant lung disease mortality, with persons in the highest tertile of exposure having a 75% increased risk for mortality (95% CI=1.15–2.66) compared with those in the lowest tertile of exposure. Persons with arsenical skin lesions were at increased risk of lung cancer mortality (hazard ratio=4.53 [95% CI=2.82–7.29]) compared with those without skin lesions. Conclusions This prospective investigation of lung disease mortality, utilizing individual-level arsenic measures and skin lesion status, confirms a deleterious effect of ingested arsenic on mortality from lung disease. Further investigations should evaluate effects on the incidence of specific lung diseases, more fully characterize dose-response, and evaluate screening and biomedical interventions to prevent premature death among arsenic-exposed populations, particularly among those who may be most susceptible to arsenic toxicity.

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Long-Term Impact of Arsenic in Drinking Water on Bladder Cancer Health Care and Mortality Rates 20 Years After End of Exposure

Cited by 70 publications

References 23 publications

Arsenic in drinking water and urinary tract cancers: a systematic review of 30 years of epidemiological evidence

Arsenic in drinking water and urinary tract cancers: a systematic review of 30 years of epidemiological evidence

Essentials of bladder cancer worldwide: incidence, mortality rate and risk factors

Arsenic and Lung Disease Mortality in Bangladeshi Adults

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