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Low-level arsenic exposure is associated with bladder cancer risk and cigarette smoking: a case–control study among men in Tunisia

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Abstract

Although exposure to high levels of arsenic is associated with excess bladder cancer risk, lower exposures generally are not. This study represents the first biomonitoring of arsenic exposure in Tunisia and focuses on a possible association with bladder cancer risk. In this context, 124 male bladder cancer cases and 220 controls were recruited and blood samples were analyzed to determine the concentration of As. The study subjects were stratified into median groups based on concentrations of arsenic in their blood. Blood arsenic (B-As) was significantly two to threefold higher in bladder cancer cases than in controls (p < 0.05). The arsenic concentrations were significantly higher among both smokers and workers in construction. However, neither drinking water nor seafood was found to be incriminated as exposure sources. The adjusted risk ratios for B-As concentration categories 0.1–0.67 and ≥0.67 μg/L were 0.18 (95% CI = 0.014–2.95) and 2.44 (95% CI = 1.11–5.35), respectively. Arsenic levels were not found to be associated with tumor grade or stage. The considerable risk in the category of highest cumulative exposure argues for an association between bladder cancer risk and low-level arsenic exposure. Future investigations with larger samples and using techniques that allow the distinction of the different arsenic species should better elucidate this association. Furthermore, the modulation of arsenic level according to the histological grade may be of potential to be used as a diagnostic marker of the disease process and its possible relationship etiologically.

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Acknowledgments

We address our acknowledgements to the medical staff in Sfax Hospital who facilitated our sampling procedures and data collection on the subjects of the study. Our thanks are also addressed to Isabel Morino and José Santiago in the Department of Toxicology and Legal Medicine, Faculty of Medicine of Granada, for their considerable assistance in the analysis of metals. We would like finally to thank Dr Najla Kharrat for his help in the statistical analysis.

Disclosure statement

The study received ethics approval. Funding was provided by the Ministry of High Education and Scientific Research in Tunisia. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflicts of interest

The authors have no conflicts to report.

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Authors and Affiliations

  1. Unit of Marine and Environmental Toxicology, IPEIS, Sfax University, BP 805, 3018, Sfax, Tunisia

    Molka Feki-Tounsi, Rim Khlifi & Amel Hamza-Chaffai

  2. Unit of Bioinformatics and Human Genetics, Center of Biotechnology of Sfax, Sfax, Tunisia

    Molka Feki-Tounsi, Rim Khlifi & Ahmed Rebai

  3. Department of Legal Medicine and Toxicology, Faculty of Medicine, University of Granada, Granada, Spain

    Pablo Olmedo & Fernando Gil

  4. Department of Urology, Habib Bourguiba Hospital, Sfax, Tunisia

    Mohamed-Nabil Mhiri

Authors
  1. Molka Feki-Tounsi
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  2. Pablo Olmedo
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  3. Fernando Gil
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  4. Rim Khlifi
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  5. Mohamed-Nabil Mhiri
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  6. Ahmed Rebai
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  7. Amel Hamza-Chaffai
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Correspondence to Molka Feki-Tounsi.

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Responsible editor: Philippe Garrigues

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Feki-Tounsi, M., Olmedo, P., Gil, F. et al. Low-level arsenic exposure is associated with bladder cancer risk and cigarette smoking: a case–control study among men in Tunisia. Environ Sci Pollut Res 20, 3923–3931 (2013). https://doi.org/10.1007/s11356-012-1335-9

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  • DOI: https://doi.org/10.1007/s11356-012-1335-9

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