American Journal of Epidemiology Vol. 147, No. 7: 660-669
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Marked Increase in Bladder and Lung Cancer Mortality in a Region of Northern Chile Due to Arsenic in Drinking Water
1 School of Public Health, University of California Berkeley, CA
2 Servicio de Salud de Antofagasta Chile
Reprint requests to Dr. Allan H. Smith, School of Public Health, 140 Warren Hall, University of California, Berkeley, CA 94720-7360.
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 µg/liter between 1955 to 1969, and decreased to less than 100 µg/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 (CI) 4.8–7.4); women, SMR = 8.2 (95% CI 6.3–10.5)) as was lung cancer mortality (men, SMR = 3.8 (95% CI 3.5–4.1); women, SMR = 3.1 (95% CI 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
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