Arsenic exposure and cancer mortality in a US-based prospective cohort: the strong heart study.
Arsenic exposure and cancer mortality in a US-based prospective cohort: the strong heart study.
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DOI：
10.1158/1055-9965.epi-13-0234-t
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发表时间：
2013-11
期刊：
影响因子：
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通讯作者：
Navas-Acien A
中科院分区：
文献类型：
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作者：
García-Esquinas E;Pollán M;Umans JG;Francesconi KA;Goessler W;Guallar E;Howard B;Farley J;Best LG;Navas-Acien A
无机砷是一种高暴露水平的致癌物，是一个重大的全球健康问题。目前还缺乏中低砷水平下致癌性的前瞻性研究。我们评估了3932名来自亚利桑那州、俄克拉荷马州和北达科他州的45-74岁的美国印第安人的基线砷暴露与癌症死亡率之间的关系，这些人参加了1989-1991年的强心脏研究，并随访至2008年。我们估计无机砷暴露为尿液中无机砷和甲基化砷的总和。癌症死亡（总体386例，肺癌78例，肝癌34例，前列腺癌18例，肾癌26例，食道/胃24例，胰腺25例，结肠/直肠32例，乳腺癌26例，淋巴/造血40例）通过死亡率监测评价进行评估。我们假设它与肺癌、肝癌、前列腺癌和肾癌有关。无机物加甲基化砷的尿浓度中位数（四分位数范围）为9.7 (5.8-15.6)μg/g肌酐。砷含量第80百分位与第20百分位的校正风险比（95% CI）为：总体癌症1.14(0.92-1.41)，肺癌1.56(1.02-2.39)，肝癌1.34(0.66,2.72)，前列腺癌3.30(1.28-8.48)，肾癌0.44（0.14,1.14）。胰腺癌的风险比为2.46(1.09-5.58)，淋巴癌和造血癌的风险比为0.46（0.22-0.96）。砷与食道癌、胃癌、结肠癌、直肠癌和乳腺癌无关。低至中等水平的无机砷暴露与肺癌、前列腺癌和胰腺癌的死亡率增加有关。这些发现支持了中低砷暴露在肺癌、前列腺癌和胰腺癌发展中的作用，并可为砷风险评估提供信息。
Inorganic arsenic, a carcinogen at high exposure levels, is a major global health problem. Prospective studies on carcinogenic effects at low-moderate arsenic levels are lacking. We evaluated the association between baseline arsenic exposure and cancer mortality in 3,932 American Indians 45–74 years from Arizona, Oklahoma and North/South Dakota who participated in the Strong Heart Study in 1989–1991 and were followed through 2008. We estimated inorganic arsenic exposure as the sum of inorganic and methylated species in urine. Cancer deaths (386 overall, 78 lung, 34 liver, 18 prostate, 26 kidney, 24 esophagus/stomach, 25 pancreas, 32 colon/rectal, 26 breast, 40 lymphatic/hematopoietic) were assessed by mortality surveillance reviews. We hypothesized an association with lung, liver, prostate and kidney cancer. Median (interquartile range) urine concentration for inorganic plus methylated arsenic species was 9.7 (5.8–15.6) μg/g creatinine. The adjusted hazard ratios (95% CI) comparing the 80th versus 20th percentiles of arsenic were 1.14 (0.92–1.41) for overall cancer, 1.56 (1.02–2.39) for lung cancer, 1.34 (0.66, 2.72) for liver cancer, 3.30 (1.28–8.48) for prostate cancer, and 0.44 (0.14, 1.14) for kidney cancer. The corresponding hazard ratios were 2.46 (1.09–5.58) for pancreatic cancer, and 0.46 (0.22–0.96) for lymphatic and hematopoietic cancers. Arsenic was not associated with cancers of the esophagus and stomach, colon and rectum, and breast. Low to moderate exposure to inorganic arsenic was prospectively associated with increased mortality for cancers of the lung, prostate and pancreas. These findings support the role of low-moderate arsenic exposure in lung, prostate and pancreas cancer development and can inform arsenic risk assessment.