title: Fifty-year study of lung and bladder cancer mortality in Chile related to arsenic in drinking water.
abstract: BACKGROUND
  Region II of Chile (the second most northerly administrative region) experienced dramatic increases in average arsenic water concentrations beginning in 1958, followed by marked declines in the 1970s when water treatment plants were installed. This history provides a unique opportunity to study time trends in the development of arsenic-related cancers, including lung and bladder cancers.
  
  
  METHODS
  We investigated lung and bladder cancer mortality from 1950 to 2000 for region II compared with region V, where drinking water was not contaminated with arsenic. Mortality data were obtained from 218,174 death certificates for the two regions for 1950-1970 and from mortality data tapes that identified 307,541 deaths in the two regions for 1971-2000. Poisson regression models were used to identify time trends in rate ratios (RRs) of mortality from lung and bladder cancers comparing region II with region V.
  
  
  RESULTS
  Lung and bladder cancer mortality rate ratios for region II compared with region V started to increase about 10 years after high arsenic exposures commenced and continued to rise until peaking in 1986-1997. The peak lung cancer mortality RRs were 3.61 (95% confidence interval [CI] = 3.13 to 4.16) for men and 3.26 (95% CI = 2.50 to 4.23) for women. The peak bladder cancer RRs were 6.10 (95% CI = 3.97 to 9.39) for men and 13.8 (95% CI = 7.74 to 24.5) for women. Combined lung and bladder cancer mortality rates in region II were highest in the period 1992-1994, with mortality rates of 153 and 50 per 100,000 men and women, respectively, in region II compared with 54 and 19 per 100,000 in region V.
  
  
  CONCLUSIONS
  Such large increases in total population cancer mortality rates have, to our knowledge, not been documented for any other environmental exposure. The long latency pattern is noteworthy, with mortality from lung and bladder cancers continuing to be high until the late 1990s, even though major decreases in arsenic exposure occurred more than 25 years earlier.
authors.affiliation: Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Marshall
authors.forename: Catterina
authors.initials: C
authors.lastname: Ferreccio
authors.forename: Yan
authors.initials: Y
authors.lastname: Yuan
authors.forename: Michael N
authors.initials: MN
authors.lastname: Bates
authors.forename: Craig
authors.initials: C
authors.lastname: Steinmaus
authors.forename: Steve
authors.initials: S
authors.lastname: Selvin
authors.forename: Jane
authors.initials: J
authors.lastname: Liaw
authors.forename: Allan H
authors.initials: AH
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001151:Arsenic / Q000032:analysis*; D020261:Arsenic Poisoning / Q000150:complications* / Q000453:epidemiology*; D002677:Chile / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced / Q000401:mortality*; D014881:Water Supply / Q000032:analysis*
chemical_list: D001151:Arsenic