Studies in Taiwan and Argentina suggest that ingestion of inorganic arsenic from drinking water results in increased risks of internal cancers, particularly bladder and lung cancer. The authors investigated cancer mortality in a population of around 400,000 people in a region of Northern Chile (Region II) exposed to high arsenic levels in drinking water in past years. Arsenic concentrations from 1950 to the present were obtained. Population-weighted average arsenic levels reached 570 /ag/liter between 1955 to 1969, and decreased to less than 100 /xg/liter by 1980. Standardized mortality ratios (SMRs) were calculated for the years 1989 to 1993. Increased mortality was found for bladder, lung, kidney, and skin cancer. Bladder cancer mortality was markedly elevated (men, SMR = 6.0 (95% confidence interval (Cl) 4.8-7.4); women, SMR = 8.2 (95% Cl 6.3-10.5)) as was lung cancer mortality (men, SMR = 3.8 (95% Cl 3.5-4.1); women, SMR = 3.1 (95% Cl 2.7-3.7)). Smoking survey data and mortality rates from chronic obstructive pulmonary disease provided evidence that smoking did not contribute to the increased mortality from these cancers. The findings provide additional evidence that ingestion of inorganic arsenic in drinking water is indeed a cause of bladder and lung cancer. It was estimated that arsenic might account for 7% of all deaths among those aged 30 years and over. If so, the impact of arsenic on the population mortality in Region II of Chile is greater than that reported anywhere to date from environmental exposure to a carcinogen in a major population. Am J Epidemiol 1998; 147:660-9. arsenic; bladder neoplasms; lung neoplasms; mortality Chronic ingestion of inorganic arsenic is an estab-lished cause of various skin effects including kerato-ses, hyperpigmentation, and skin cancer (1). More recently, studies in Taiwan (2-9) have raised the pos-sibility that ingestion of arsenic in drinking water was also a cause of several internal cancers including blad-der, kidney, liver, and lung cancer. Extremely large relative risks can be estimated from the ecologic mor-tality study in Taiwan, the greatest being for bladder cancer. At the highest level of exposure, around 800 /ig/liter, relative risk estimates for bladder cancer mor-tality were 28.7 for men and 65.4 for women (4, 10). A subsequent study in an arsenic-exposed region of Argentina also found increased bladder cancer mortal-ity. The bladder cancer relative risks for the highest exposed areas were 2.1 for men and 1.8 for women when compared with the rest of the country (11).
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