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Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 149-151

Exposure to a high level of arsenic in drinking water and the risk of bladder cancer in Taiwan

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Date of Submission29-Dec-2020
Date of Decision05-Mar-2021
Date of Acceptance05-Mar-2021
Date of Web Publication26-Mar-2021

Correspondence Address:
Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_374_20

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How to cite this article:
Okechukwu CE. Exposure to a high level of arsenic in drinking water and the risk of bladder cancer in Taiwan. Cancer Res Stat Treat 2021;4:149-51

How to cite this URL:
Okechukwu CE. Exposure to a high level of arsenic in drinking water and the risk of bladder cancer in Taiwan. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Apr 23];4:149-51. Available from: https://www.crstonline.com/text.asp?2021/4/1/149/312098

Arsenate (AsV) and arsenite (AsIII) are commonly detected in well water.[1] AsIII is more toxic, and it is a known risk factor for bladder cancer (BCa); AsIII and methyltransferase gene might play a part in the development of BCa by controlling inorganic arsenic metabolism.[2] In humans, arsenic in its mineral form is transformed to monomethylarsonic acid and dimethylarsinic acid in a detoxification process.[1] The diffusion of some organic and nitrogenous compounds from anthropogenic sources into the groundwater can cause arsenic mobilization in the aquifer.[3]

A multivariate regression and post hoc analysis conducted by Lin et al. showed that exposure to high arsenic concentration in drinking water led to an increased incidence of liver cancer in Taiwan, but such an impact was not noticeable at an exposure level <0.64 mg/L. This corroborates the fact that exposure to a higher level of arsenic is linked to carcinogenesis.[4] Moreover, Chen et al.[5] found that patients with arsenic-related BCa might have reduced chances of survival because of their tumor phenotypes. The prevalence of BCa in villages that rely on artesian well water might be because of arsenic acting as an elevated-dose carcinogen or as a co-cancer causing agent with humic acid in artesian well water.[6] Based on the outcome of a prolonged follow-up study of residents in endemic areas, arsenic ingested from drinking artesian well-water and the associated deoxyribonucleic acid lesions increased the risk of BCa in northeastern Taiwan.[7] Interestingly, Yang et al.[8] estimated the standardized mortality ratios for BCa in the blackfoot disease (BFD)-prevalent area in southwestern Taiwan from 1971 to 2000. The outcome of their quantitative analysis showed that the mortality rate due to BCa reduced progressively after upgrading the drinking water supply system to remove arsenic and its associated compounds from artesian well water. This discovery was further evidence that the exposure to arsenic present in artisan well water may have accounted for the diagnosed cases of BCa in the BFD-endemic area and mortality due to cancer.[8] Several researchers found a significant correlation between the degree of exposure to higher levels of arsenic in artesian well water and the risk of BCa in the southwestern and northeastern areas in Taiwan [Table 1]. Moreover, elevated concentration of arsenic in the urine was correlated with a high risk of BCa.[17]
Table 1: Summary of studies on exposure to a high arsenic level in drinking water and risk of bladder cancer in Taiwan

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In conclusion, exposure to the high concentration of arsenic over a long period through drinking artesian well water was associated with the occurrence of BCa in Taiwan, particularly in the arsenian-endemic areas of Southwest and Northeast Taiwan. Moreover, the prevalence of high-grade tumors was more in the BFD-endemic area. Proper evaluation of the risk of BCa on exposure to a lower concentration of arsenic over a longer period requires further investigation.

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  References Top

Pu YS, Yang SM, Huang YK, Chung CJ, Huang SK, Chiu AW, et al. Urinary arsenic profile affects the risk of urothelial carcinoma even at low arsenic exposure. Toxicol Appl Pharmacol 2007;218:99-106.  Back to cited text no. 1
Song Y, Jin D, Chen J, Liang W, Liu X. Effects of arsenic (+3 Oxidation State) methyltransferase gene polymorphisms and expression on bladder cancer: Evidence from a systematic review, meta-analysis and TCGA dataset. Toxicol Sci 2020;177:27-40.  Back to cited text no. 2
Liu C, Wu M. Geochemical, mineralogical and statistical characteristics of arsenic in groundwater of the lanyang plain, Taiwan. J Hydrol 2019;577:123975.  Back to cited text no. 3
Lin HJ, Sung TI, Chen CY, Guo HR. Arsenic levels in drinking water and mortality of liver cancer in Taiwan. J Hazard Mater 2013;262:1132-8.  Back to cited text no. 4
Chen CH, Chiou HY, Hsueh YM, Chen CJ, Yu HJ, Pu YS. Clinicopathological characteristics and survival outcome of arsenic related bladder cancer in Taiwan. J Urol 2009;181:547-52.  Back to cited text no. 5
Lamm SH, Byrd DM, Kruse MB, Feinleib M, Lai SH. Bladder cancer and arsenic exposure: Differences in the two populations enrolled in a study in southwest Taiwan. Biomed Environ Sci 2003;16:355-68.  Back to cited text no. 6
Tsai TL, Kuo CC, Hsu LI, Tsai SF, Chiou HY, Chen CJ, et al. Association between arsenic exposure, DNA damage, and urological cancers incidence: A long-term follow-up study of residents in an arseniasis endemic area of northeastern Taiwan. Chemosphere 2021;266:129094.  Back to cited text no. 7
Yang CY, Chiu HF, Chang CC, Ho SC, Wu TN. Bladder cancer mortality reduction after installation of a tap-water supply system in an arsenious-endemic area in southwestern Taiwan. Environ Res 2005;98:127-32.  Back to cited text no. 8
Liao PJ, Hsu KH, Chiou HY, Che CJ, Lee CH. Joint effects of genomic markers and urinary methylation capacity associated with inorganic arsenic metabolism on the occurrence of cancers among residents in arseniasis-endemic areas: A cohort subset with average fifteen-year follow-up. Biomed J 2020;[published online ahead of print, 2020 Oct 13].  Back to cited text no. 9
Chung CJ, Huang YL, Huang YK, Wu MM, Chen SY, Hsueh YM, et al. Urinary arsenic profiles and the risks of cancer mortality: A population-based 20-year follow-up study in arseniasis-endemic areas in Taiwan. Environ Res 2013;122:25-30.  Back to cited text no. 10
Hsu LI, Chen WP, Yang TY, Chen YH, Lo WC, Wang YH, et al. Genetic polymorphisms in glutathione S-transferase (GST) superfamily and risk of arsenic-induced urothelial carcinoma in residents of southwestern Taiwan. J Biomed Sci 2011;18:51.  Back to cited text no. 11
Huang YK, Huang YL, Hsueh YM, Yang MH, Wu MM, Chen SY, et al. Arsenic exposure, urinary arsenic speciation, and the incidence of urothelial carcinoma: A twelve-year follow-up study. Cancer Causes Control 2008;19:829-39.  Back to cited text no. 12
Chen CL, Chiou HY, Hsu LI, Hsueh YM, Wu MM, Wang YH, et al. Arsenic in drinking water and risk of urinary tract cancer: A follow-up study from northeastern Taiwan. Cancer Epidemiol Biomarkers Prev 2010;19:101-10.  Back to cited text no. 13
Chiou HY, Chiou ST, Hsu YH, Chou YL, Tseng CH, Wei ML, et al. Incidence of transitional cell carcinoma and arsenic in drinking water: A follow-up study of 8,102 residents in an arseniasis-endemic area in northeastern Taiwan. Am J Epidemiol 2001;153:411-8.  Back to cited text no. 14
Chiou HY, Hsueh YM, Liaw KF, Horng SF, Chiang MH, Pu YS, et al. Incidence of internal cancers and ingested inorganic arsenic: A seven-year follow-up study in Taiwan. Cancer Res 1995;55:1296-300.  Back to cited text no. 15
Chen CJ, Chuang YC, You SL, Lin TM, Wu HY. A retrospective study on malignant neoplasms of bladder, lung and liver in blackfoot disease endemic area in Taiwan. Br J Cancer 1986;53:399-405.  Back to cited text no. 16
Deb AA, Okechukwu CE, Emara S, Sami AA. Occupational exposure as risk factor for kidney and bladder cancer: A systematic review and meta-analysis. Urol Nephrol Open Access J 2019;7:143-51.  Back to cited text no. 17


  [Table 1]


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