Dalsu Baris1, Richard Waddell2, Laura E Beane Freeman2, Molly Schwenn2, Joanne S Colt2, Joseph D Ayotte2, Mary H Ward2, John Nuckols2, Alan Schned2, Brian Jackson2, Castine Clerkin2, Nathaniel Rothman2, Lee E Moore2, Anne Taylor2, Gilpin Robinson2, Gm Monawar Hosain2, Karla R Armenti2, Richard McCoy2, Claudine Samanic2, Robert N Hoover2, Joseph F Fraumeni2, Alison Johnson2, Margaret R Karagas2, Debra T Silverman1. 1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ). dalsubaris@gmail.com silvermd@mail.nih.gov. 2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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 wells (which are vulnerable to contamination from manmade sources, Ptrend = .002) but not if well water was supplied only by deeper drilled wells (Ptrend = .48). If dug wells were used pre-1960, when arsenical pesticides were widely used in the region, heavier water consumers (>2.2 L/day) had double the risk of light users (<1.1 L/day, Ptrend = .01). Among all participants, cumulative arsenic exposure from all water sources, lagged 40 years, yielded a positive risk gradient (Ptrend = .004); among the highest-exposed participants (97.5th percentile), risk was twice that of the lowest-exposure quartile (odds ratio = 2.24, 95% confidence interval = 1.29 to 3.89). CONCLUSIONS: Our findings support an association between low-to-moderate levels of arsenic in drinking water and bladder cancer risk in New England. In addition, historical consumption of water from private wells, particularly dug wells in an era when arsenical pesticides were widely used, was associated with increased bladder cancer risk and may have contributed to the New England excess. Published by Oxford University Press 2016. This work is written by US Government employees and is in the public domain in the United States.
BACKGROUND: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. METHODS: 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. RESULTS: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 wells (which are vulnerable to contamination from manmade sources, Ptrend = .002) but not if well water was supplied only by deeper drilled wells (Ptrend = .48). If dug wells were used pre-1960, when arsenical pesticides were widely used in the region, heavier water consumers (>2.2 L/day) had double the risk of light users (<1.1 L/day, Ptrend = .01). Among all participants, cumulative arsenic exposure from all water sources, lagged 40 years, yielded a positive risk gradient (Ptrend = .004); among the highest-exposed participants (97.5th percentile), risk was twice that of the lowest-exposure quartile (odds ratio = 2.24, 95% confidence interval = 1.29 to 3.89). CONCLUSIONS: Our findings support an association between low-to-moderate levels of arsenic in drinking water and bladder cancer risk in New England. In addition, historical consumption of water from private wells, particularly dug wells in an era when arsenical pesticides were widely used, was associated with increased bladder cancer risk and may have contributed to the New England excess. Published by Oxford University Press 2016. This work is written by US Government employees and is in the public domain in the United States.
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