title: Experience with primary urethral carcinoma from the blackfoot disease-endemic area of South Taiwan: increased frequency of bulbomembranous adenocarcinoma?
abstract: OBJECTIVE
  To describe and compare primary urethral carcinomas in South Taiwan with those in the USA and to explore the influence of chronic arsenic exposure.
  
  
  METHODS
  From 1988 to 2001, there were 21 pathologically proven primary urethral carcinomas diagnosed and treated at our hospital (14 males, 7 females). Seven of 14 male patients were chronically exposed to arsenic in drinking water for an average of 23 years. We compared our cases to three studies in the USA (80 males, 179 females), and analyzed the influence of chronic arsenic exposure by onset age, histology, staging, and outcome.
  
  
  RESULTS
  Male patients with localized tumors had better survival compared to those with advanced tumors (p = 0.0045 in males, p = 0.07 in females). In comparison to the three studies in the USA, there was an unusual higher frequency of bulbomembranous adenocarcinoma at our center (43 vs. 18%, 2 and 0%, respectively, p < 0.0001), particularly among those with chronic arsenic exposure (73 vs. 14%, p = 0.031).
  
  
  CONCLUSIONS
  In South Taiwan, there was a high frequency of bulbomembranous urethral adenocarcinoma, which might be associated with chronic arsenic exposure. Although the implications of such an observation are minimal owing to its rarity, it is worth exploring.
authors.affiliation: Institute of Clinical Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
authors.forename: Yuh-Shyan
authors.initials: YS
authors.lastname: Tsai
authors.forename: Wen-Horng
authors.initials: WH
authors.lastname: Yang
authors.forename: Yat-Ching
authors.initials: YC
authors.lastname: Tong
authors.forename: Johnny S N
authors.initials: JS
authors.lastname: Lin
authors.forename: Chen-Ching
authors.initials: CC
authors.lastname: Pan
authors.forename: Tzong-Shin
authors.initials: TS
authors.lastname: Tzai
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001151:Arsenic / Q000009:adverse effects* / Q000032:analysis; D020261:Arsenic Poisoning / Q000150:complications / Q000453:epidemiology*; D002908:Chronic Disease; D019353:Endemic Diseases; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013624:Taiwan / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014523:Urethral Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D014874:Water Pollutants, Chemical / Q000009:adverse effects* / Q000032:analysis; D014881:Water Supply / Q000032:analysis
chemical_list: D014874:Water Pollutants, Chemical; D001151:Arsenic