Fifty-year study of lung and bladder cancer mortality in Chile related to arsenic in drinking water.

BACKGROUND Region II of Chile (the second most northerly administrative region) experienced dramatic increases in average arsenic water concentrations beginning in 1958, followed by marked declines in the 1970s when water treatment plants were installed. This history provides a unique opportunity to study time trends in the development of arsenic-related cancers, including lung and bladder cancers. METHODS We investigated lung and bladder cancer mortality from 1950 to 2000 for region II compared with region V, where drinking water was not contaminated with arsenic. Mortality data were obtained from 218,174 death certificates for the two regions for 1950-1970 and from mortality data tapes that identified 307,541 deaths in the two regions for 1971-2000. Poisson regression models were used to identify time trends in rate ratios (RRs) of mortality from lung and bladder cancers comparing region II with region V. RESULTS Lung and bladder cancer mortality rate ratios for region II compared with region V started to increase about 10 years after high arsenic exposures commenced and continued to rise until peaking in 1986-1997. The peak lung cancer mortality RRs were 3.61 (95% confidence interval [CI] = 3.13 to 4.16) for men and 3.26 (95% CI = 2.50 to 4.23) for women. The peak bladder cancer RRs were 6.10 (95% CI = 3.97 to 9.39) for men and 13.8 (95% CI = 7.74 to 24.5) for women. Combined lung and bladder cancer mortality rates in region II were highest in the period 1992-1994, with mortality rates of 153 and 50 per 100,000 men and women, respectively, in region II compared with 54 and 19 per 100,000 in region V. CONCLUSIONS Such large increases in total population cancer mortality rates have, to our knowledge, not been documented for any other environmental exposure. The long latency pattern is noteworthy, with mortality from lung and bladder cancers continuing to be high until the late 1990s, even though major decreases in arsenic exposure occurred more than 25 years earlier.

[1]  A. Smith,et al.  Pregnancy outcomes, infant mortality, and arsenic in drinking water in West Bengal, India. , 2006, American journal of epidemiology.

[2]  Steve Selvin,et al.  Increased Mortality from Lung Cancer and Bronchiectasis in Young Adults after Exposure to Arsenic in Utero and in Early Childhood , 2006, Environmental health perspectives.

[3]  J. Balmes,et al.  Bronchiectasis in Persons With Skin Lesions Resulting From Arsenic in Drinking Water , 2005, Epidemiology.

[4]  A. Smith,et al.  The temporal stability of arsenic concentrations in well water in western Nevada. , 2005, Environmental research.

[5]  J. Balmes,et al.  Decrements in lung function related to arsenic in drinking water in West Bengal, India. , 2005, American journal of epidemiology.

[6]  Raimundo Soto,et al.  SPATIAL INEQUALITY, MIGRATION AND ECONOMIC GROWTH IN CHILE , 2004 .

[7]  Chun-Yuh Yang,et al.  Lung cancer mortality reduction after installation of tap-water supply system in an arseniasis-endemic area in Southwestern Taiwan. , 2004, Lung cancer.

[8]  Arindam Basu,et al.  Nutritional Factors and Susceptibility to Arsenic-Caused Skin Lesions in West Bengal, India , 2004, Environmental health perspectives.

[9]  M. Bates,et al.  Case-control study of bladder cancer and exposure to arsenic in Argentina. , 2004, American journal of epidemiology.

[10]  Craig Steinmaus,et al.  Case-control study of bladder cancer and drinking water arsenic in the western United States. , 2003, American journal of epidemiology.

[11]  I. Hertz-Picciotto,et al.  Arsenic Exposure from Drinking Water and Birth Weight , 2003, Epidemiology.

[12]  M. H. Smith,et al.  Arsenic in drinking water and skin lesions , 2003 .

[13]  M. H. Smith,et al.  Arsenic in Drinking Water and Skin Lesions: Dose-Response Data from West Bengal, India , 2003, Epidemiology.

[14]  S. Devries,et al.  Arsenic-related chromosomal alterations in bladder cancer. , 2002, Journal of the National Cancer Institute.

[15]  D. Nordstrom.  Worldwide Occurrences of Arsenic in Ground Water , 2002, Science.

[16]  J. V. van Wijnen,et al.  Daily Mortality and Air Pollution along Busy Streets in Amsterdam, 1987–1998 , 2001, Epidemiology.

[17]  C. Chen,et al.  Incidence of transitional cell carcinoma and arsenic in drinking water: a follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan. , 2001, American journal of epidemiology.

[18]  Guillermo Marshall,et al.  Lung Cancer and Arsenic Concentrations in Drinking Water in Chile , 2000, Epidemiology.

[19]  John M. Lachin,et al.  Biostatistical Methods: The Assessment of Relative Risks , 2000 .

[20]  A H Smith,et al.  Lung and kidney cancer mortality associated with arsenic in drinking water in Córdoba, Argentina. , 1998, International journal of epidemiology.

[21]  A H Smith,et al.  Marked increase in bladder and lung cancer mortality in a region of Northern Chile due to arsenic in drinking water. , 1998, American journal of epidemiology.

[22]  C. Hopenhayn-Rich,et al.  Bladder Cancer Mortality Associated with Arsenic in Drinking Water in Argentina , 1996, Epidemiology.

[23]  Y. Hsueh,et al.  Incidence of internal cancers and ingested inorganic arsenic: a seven-year follow-up study in Taiwan. , 1995, Cancer research.

[24]  A H Smith,et al.  Case-control study of bladder cancer and arsenic in drinking water. , 1995, American journal of epidemiology.

[25]  A. Smith,et al.  Increased micronuclei in exfoliated bladder cells of individuals who chronically ingest arsenic-contaminated water in Nevada. , 1994, Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology.

[26]  J Schwartz,et al.  Air pollution and daily mortality in Birmingham, Alabama. , 1993, American journal of epidemiology.

[27]  B. Gillespie,et al.  Patterns of absolute risk of lung cancer mortality in former smokers. , 1993, Journal of the National Cancer Institute.

[28]  C. J. Chen,et al.  Ecological correlation between arsenic level in well water and age-adjusted mortality from malignant neoplasms. , 1990, Cancer research.

[29]  Chien-Jen Chen,et al.  Atherogenicity and Carcinogenicity of High‐Arsenic Artesian Well Water: Multiple Risk Factors and Related Malignant Neoplasms of Blackfoot Disease , 1988, Arteriosclerosis.

[30]  T. Hastie,et al.  Generalized Additive Models , 1986 .

[31]  G. Mardones,et al.  Certificacion medica de las defunciones de los servicios de salud de chile , 1986 .

[32]  S. You,et al.  A retrospective study on malignant neoplasms of bladder, lung and liver in blackfoot disease endemic area in Taiwan. , 1986, British Journal of Cancer.

[33]  C. J. Chen,et al.  Malignant neoplasms among residents of a blackfoot disease-endemic area in Taiwan: high-arsenic artesian well water and cancers. , 1985, Cancer research.

[34]  O. Axelson.  Aspects on confounding in occupational health epidemiology. , 1978, Scandinavian journal of work, environment & health.

[35]  A. Morrison,et al.  Epidemiology of bladder cancer. , 1992, Hematology/oncology clinics of North America.

[36]  J. A. Roberson,et al.  Some drinking-water disinfectants and contaminants, including arsenic. , 2004, IARC monographs on the evaluation of carcinogenic risks to humans.