MW-year study of lung and bladder canceir mortality in Chile related to arsenic in drinking water

Background Region 11 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 11 compared with region V, where drinking water was not contaminated with arsenic. Mortality data were obtained from 218174 death certificates for the two regions for 1950-1970 and from mortality data tapes that identified 307541 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 11 with region V. Results Lung and bladder cancer mortality rate ratios for region 11 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 [Cl] = 3.13 to 4.16) for men and 3.26 (95% Cl = 2.50 to 4.23) for women. The peak bladder cancer RRs were 6.10 (95% Cl = 3.97 to 9.39) for men and 13.8 (95% Cl = 7.74 to 24.5) for women. Combined lung and bladder cancer mortality rates in region 11 were highest in the period 1992-1994, with mortality rates of 153 and 50 per 100000 men and women, respectively, in region 11 compared with 54 and 19 per 100000 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.