Abstract
Objective: The association between arsenic ingestion and cancer has been documented for more than a century. Previous studies showed that the carcinogenic effects of arsenic on the urinary system are cell-type specific. To evaluate whether this is also true for skin cancers, we conducted an ecological study in 243 townships in Taiwan. Methods: The arsenic exposure was assessed on the basis of measurement reports from a previous survey, and cases of skin cancer were identified using the information gathered by the National Cancer Registry Program. We analyzed the data by regression models using multiple variables to describe the exposure status, and an urbanization index was also included in the models to adjust for the effects of urbanization. Results: A total of 2369 patients with skin cancer, comprising 1415 men and 954 women, were registered between 1 January 1980 and 31 December 1989. Among the three major cell types of skin cancer, squamous cell carcinoma and basal cell carcinoma appear to be associated with ingestion of arsenic. Such an association was not observed for malignant melanoma. Conclusions: The results suggested that the carcinogenicity of arsenic on skin is cell-type specific, which is compatible with the findings in previous studies on urinary cancers.
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References
Yeh S (1963) Relative incidence of skin cancer in Chinese in Taiwan: with special reference to arsenical cancer. Monogr Natl Cancer Inst 10: 81-107.
Chen K-P, Wu H-Y, Yeh C-C, Cheng Y-J (1979) Color Atlas of Cancer Mortality by Administrative and Other Classified Districts in Taiwan Area: 1968–1976. Taipei, Taiwan: National Science Council, NSC Special Publication No. 2.
Tseng W-P, Chu H-M, How S-H, Fong J-M, Lin C-S, Yeh S (1968) Prevalence of skin cancer in an endemic area of chronic arsenicism in Taiwan. J Nat Cancer Inst 40: 453-463.
Environmental Protection Agency (1984) Health Assessment Document for Inorganic Arsenic: Final Report. Washington, DC: US Environmental Protection Agency, EPA Publication EPA-600/8-83-022F.
Risk Assessment Forum (1988) Special Report on Ingested Inorganic Arsenic: Skin Cancer; Nutritional Essentiality. Washington, DC: US Environmental Protenction Agency, US EPA 625/3-87/013.
Chen C-J, Chuang Y-C, Lin T-M, Wu H-Y (1985) Malignant neoplasms among residents of a blackfoot disease endemic area in Taiwan: high-arsenic artisan well water and cancers. Cancer Res 45: 5895-5899.
Chen C-J, Kuo T-L, Wu M-M (1988) Arsenic and cancers. Lancet 1: 414-415.
Wu M-M, Kuo T-L, Hwang Y-H, Chen C-J (1989) Dose-response relation between arsenic concentration in well water and mortality from cancers and vascular diseases. Am J Epidemiol 130: 1123-1132.
Brown KG, Chen C-J (1995) Significance of exposure assessment to analysis of cancer risk from inorganic arsenic in drinking water in Taiwan. Risk Analysis 15: 475-484.
Chen C-J, Wang C-J (1990) Ecological correlation between arsenic level in well water and age-adjusted mortality from malignant neoplasms. Cancer Res 50: 5470-5474.
Lo M-C, Hsen Y-C, Lin B-K (1977) Second Report on the Investigation of Arsenic Content in Underground Water in Taiwan. Taichung, Taiwan: Taiwan Provincial Institute of Environmental Sanitation.
Guo H-R, Chen C-J, Greene HL (1994) Arsenic in drinking water and Cancers: a descriptive review of Taiwan studies. In: Chappell WR, Abernathy CO, Cothern CR, eds. Arsenic: Exposure and Health. Special Issue of Environmental Geochemistry and Health, vol. 16. Northwood, UK: Science and Technology Letters, pp. 129-138.
Guo H-R, Chiang H-S, Hu H, Lipsitz SR, Monson RR (1997) Arsenic in drinking water and incidence of urinary cancers. Epidemiology 8: 545-550.
American Public Health Association (1985) Standard Methods of the Evaluation of Water and Water Waste. Washington, DC: American Public Health Association.
Greschonig H, Irgolic KJ (1995) The mercuric bromide stain method for the determination of arsenic: implications for the epidemiological studies in Taiwan. In: SEGH Second International Conference on Arsenic Exposure and Health Effects, Book of Abstracts. San Diego, CA: Society for Environmental Geochemistry and Health.
Guo H-R, Lipsitz SR, Hu H, Monson RR (1994) The dose-response relationship between arsenic in drinking water and skin cancers. In: Workshop on Arsenic: Epidemiology and PBPK Modeling, Book of Abstracts. Annapolis, MD: Society for Environmental Geochemistry and Health.
World Health Organization (1976) International Classification of Diseases for Oncology, 1st edn. Geneva: World Health Organization.
Guo H-R, Lipsitz SR, Hu H, Monson RR (1998) Using ecological data to estimate a regression model for individual data: the association between arsenic in drinking water and incidence of skin cancer. Environ Res 79: 82-93.
Rosenbaum PR, Rubin DB (1984) Difficulties with regression analysis of age-adjusted rates. Biometrics 40: 437-443.
Wu S-Y (1986) Report on the Degree of Urbanization of Precincts and Townships in Taiwan. Taipei, Taiwan: Bureau of Statistics, Executive Yuan.
Hutchinson J (1887) Arsenic cancer. Br Med J 2: 1280-1281.
Hutchinson J (1888) On some examples of arsenic-keratosis of the skin and of arsenic-cancer. Trans Pathol Soc Lond 39: 352-363.
Lagerholm B, Skog E (1968) Squamous cell carcinoma in psoriasis vulgaris. Three cases of squamous cell carcinoma developing in psoriatic lesions. Acta Dermato-Venereologica 48: 128-136.
Southwick GJ, Schwartz RA (1979) Arsenically associated cutaneous squamous cell carcinoma with hypercalcemia. J Surg Oncol 12: 115-118.
Ismail R, Cheng PS (1988) Multiple Bowen's disease associated with squamous cell carcinoma — a report of a case. J Dermatol 15: 65-67.
Andrews PE, Farrow GM, Oesterling JE (1991). Squamous cell carcinoma of the scrotum: long-term folowup of 14 patients. J Urol 146: 1299-1304.
Hsu CH, Yang SA, Wang JY, Yu HS, Lin SR (1999) Mutational spectrum of p53 gene in arsenic-related skin cancers from the blackfoot disease endemic area of Taiwan. Br J Cancer 80: 1080-1086.
Jackson R, Grainge JW (1975) Arsenic and cancer. Can Med Assoc J 113: 396-401.
Bruynzeel I, Bergman W, Hartevelt HM, et al. (1991) High singledose European PUVA regimen also causes an excess of non-melanoma skin cancer. Br J Dermatol 124: 49-55.
Huang YZ, Qian XC, Wang GQ, et al. (1992) Syndrome of endemic arsenism and fluorosis. A clinical study. Chinese Med J 105: 586-590.
Wagner SL, Maliner JS, Morton WE, Braman RS (1979) Skin cancer and arsenical intoxication from well water. Arch Dermatol 115: 1205-1207.
Roat JW, Wald A, Mendelow H, Pataki KI (1982) Hepatic angiosarcoma associated with short-term arsenic ingestion. Am J Med 73: 933-936.
Nakjang Y, Kullavanijaya P (1994) Basal cell carcinoma: seven years' experience at the Institute of Dermatology in Bangkok. J Dermatol 21: 660-663.
Mowad CM, Jaworsky C, Werth VP (1996) Numerous erythematous truncal plaques. Multiple basal cell carcinomas associated with arsenic ingestion. Arch Dermatol 132: 1105-1106, 1108–1109.
Wong SS, Tan KC, Goh CL (1998) Cutaneous manifestations of chronic arsenicism: review of seventeen cases. J Am Acad Dermatol 38: 179-185.
Kim HJ, Min HG, Lee ES (1999). Bowen's diseases and basal cell carcinomas in a patient. J Dermatol 26: 695-697.
Boonchai W, Walsh M, Cummings M, Chenevix-Trench G (2000) Expression of p53 in arsenic-related and sporadic basal cell carcinoma. Arch Dermatol 136: 195-198.
Yeh S, How SW, Lin CS (1968) Arsenical cancer of skin. Histologic study with special reference to Bowen's disease. Cancer 21: 312-239.
Yeh S, Chen HC, How SW, Deng CS (1974) Fine structure of Bowen's disease in chronic arsenicalism. J Natl Cancer Inst 53: 31-44.
Upshaw CB Jr, Bryant MF, Claiborne TS Jr (1979) Noncirrhotic portal hypertension after arsenic ingestion. South Med J 72: 1332-1324.
Heddle R, Bryant GD (1983). Small cell lung carcinoma and Bowen's disease 40 years after arsenic ingestion. Chest 84: 776-777.
Tan SH, Tham SN, Goh CL (1995) Skin cancers at Tertiary Referral Skin Hospital in Singapore. Int J Dermatol 34: 770-776.
Murata K, Iwazawa T, Takayama T, Yamashita K, Okagawa K (1994) Quadruple cancer including Bowen's disease after arsenic injections 40 years earlier: report of a case. Surg Today 24: 1115-1118.
Ohnishi Y, Murakami S, Ohtsuka H, Miyauchi S, Shinmori H, Hashimoto K (1997) Merkel cell carcinoma and multiple Bowen's disease: incidental association or possible relationship to inorganic arsenic exposure? J Dermatol 24: 310-316.
Tsuruta D, Hamada T, Mochida K, Nakagawa K, Kobayashi H, Ishii M (1998) Merkel cell carcinoma, Bowen's disease and chronic occupational arsenic poisoning. Br J Dermatol 139: 291-294.
Lien HC, Tsai TF, Lee YY, Hsiao CH (1999) Merkel cell carcinoma and chronic arsenicism. J Am Acad Dermatol 41: 641-643.
Shneidman D, Belizaire R (1986) Arsenic exposure followed by the development of dermatofibrosarcoma protuberans. Cancer 58: 1585-1587.
Yu HS, Chiou KS, Chen GS, Yang RC, Chang SF (1993) Progressive alterations of cytokeratin expressions in the process of chronic arsenism. J Dermatol 20: 741-745.
Guo H-R, Valberg PA (1997) Evaluation of the validity of the US EPA's cancer risk assessment for arsenic for low-level exposures: A likelihood ratio approach. Environ Geochem Health 19: 133-141.
Environmental Protection Agency (2001) National primary drinking water regulations: Arsenic and clarifications to compliance and new source contaminants monitoring; Final rule. Fed Reg 66: 6976-7066.
Lu F-J, Guo H-R, Chiang H-S, Hong C-L (1986) Relationships between the fluorescent intensity of well water and the incidence rate of bladder cancer. J Chinese Oncol Soc 2: 134-143.
Marcus WL, Rispin AS (1988) Threshold carcinogenicity using arsenic as an example. In: Cothern CR, Mehlman MA, Marcus WL, eds. Advanced Modern Environmental Toxicology, vol. XV: Risk Assessment and Risk Management of Industrial and Environmental Chemicals. Princeton, NJ: Princeton Publishing Co.
Uthus EO (1992) Evidence for arsenic essentiality. Environ Geochem Health 14: 55-58.
Mayer DR, Kosmus W, Pogglitsch H, Mayer D, Beyer W (1993) Essential trace elements in humans. Serum arsenic concentrations in hemodialysis patients in comparison to healthy controls. Biol Trace Elem Res 37: 27-38.
Störer G (1991) Arsenic: opportunity for risk assessment. Arch Toxicol 65: 525-531.
Marczynski B (1988) Careinogenesis as the result of the deficiency of some essential trace elements. Med Hypoth 26: 239-249.
Karagas MR, Stukel TA, Morris JS, et al. (2001) Skin cancer risk in relation to toenail arsenic concentrations in a US population-based case-control study. Am J Epidemiol 153: 559-565.
Guo H-R (1997) Arsenic in drinking water and skin cancer: comparison among studies based on cancer registry, death certificates, and physical examinations. In: Abernathy CO, Cothern CR, Chappell WR, eds. Arsenic: Exposure and Health Effects. London: Chapman & Hall, pp. 234-259.
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Guo, HR., Yu, HS., Hu, H. et al. Arsenic in drinking water and skin cancers: cell-type specificity (Taiwan, R.O.C.). Cancer Causes Control 12, 909–916 (2001). https://doi.org/10.1023/A:1013712203455
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DOI: https://doi.org/10.1023/A:1013712203455