title: Arsenic exposure predicts bladder cancer survival in a US population.
abstract: OBJECTIVE
  Chronic arsenic exposure at levels found in US drinking water has been associated with bladder cancer. While arsenic is a known carcinogen, recent studies suggest that it is useful as a therapeutic agent for leukemia. This study examined the relationship between arsenic exposure and bladder cancer mortality.
  
  
  METHODS
  We studied 832 cases of bladder cancer diagnosed in New Hampshire from a population-based case-control study. Individual exposure to arsenic was determined in home drinking water using ICP-MS and in toenail samples by instrumental neutron activation analysis.
  
  
  RESULTS
  Among the high arsenic exposure group, found using toenail arsenic level or arsenic consumption, cases experienced a de-escalated survival hazard ratio (HR) [high (> or =75 percent) versus low (<25th percentile) toenail arsenic overall survival HR 0.5 (95% CI 0.4-0.8)], controlled for tumor stage, grade, gender, age and treatment regimen. This association was found largely among invasive tumors, in smokers and was not modified by TP53 status. Bladder cancer cause-specific survival showed a similar trend, but did not reach statistical significance [HR 0.5 (95% CI 0.3-1.1)].
  
  
  CONCLUSIONS
  Arsenic exposure may be related to the survival of patients with bladder cancer.
authors.affiliation: Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Norris Cotton Cancer Center, Dartmouth Medical School, 7927 Rubin 860 One Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Ryan C
authors.initials: RC
authors.lastname: Kwong
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Karagas
authors.forename: Karl T
authors.initials: KT
authors.lastname: Kelsey
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Mason
authors.forename: Sam A
authors.initials: SA
authors.lastname: Tanyos
authors.forename: Alan R
authors.initials: AR
authors.lastname: Schned
authors.forename: Carmen J
authors.initials: CJ
authors.lastname: Marsit
authors.forename: Angeline S
authors.initials: AS
authors.lastname: Andrew
mesh_terms: D000328:Adult; D000368:Aged; D001151:Arsenic / Q000032:analysis*; D016022:Case-Control Studies; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000737:chemistry; D009513:New Hampshire / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012907:Smoking / Q000401:mortality; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000401:mortality*; D014881:Water Supply / Q000706:statistics & numerical data*
chemical_list: D001151:Arsenic