title: Occupational exposure to herbs containing aristolochic acids increases the risk of urothelial carcinoma in Chinese herbalists.
abstract: OBJECTIVE
  Aristolochic acid can cause urothelial carcinoma. Herbal remedies containing aristolochic acids were previously categorized as proven group 1 human carcinogens by the WHO cancer agency, the International Agency for Research on Cancer. However, the health effect on workers exposed to aristolochic acid is unclear. Fangchi, a representative herb containing aristolochic acid, is commonly used in the Chinese herbal medicine industry. We determined whether workers exposed to fangchi are at increased risk for urothelial carcinoma.
  
  
  METHODS
  We designed a case-control study based in a national representative cohort of Chinese herbalists. This study analyzed 6,564 Chinese herbalists employed between 1985 and 1998. All incident cases of urothelial carcinoma that occurred between 1988 and 2001 were defined as the case group. Controls were selected from the baseline cohort in a randomized manner. A total of 24 cases and 140 controls were included in analysis. Information about fangchi exposure was obtained in a questionnaire survey administered in 2002.
  
  
  RESULTS
  Processing, selling or dispensing herbs containing fangchi significantly increased the risk of urothelial carcinoma (HR 2.4, 95% CI 1.1-5.3, p = 0.03). This relationship was independent of cigarette smoking or potential arsenic exposure from drinking water from deep wells.
  
  
  CONCLUSIONS
  Exposure to the Chinese herbal drug fangchi increases the risk of urothelial carcinoma in herbalists. Appropriate medical monitoring is warranted for workers who have similar exposure.
authors.affiliation: Department of Occupational Medicine, Buddhist Tzu Chi General Hospital and School of Medicine, Tzu Chi University, Hualien, Taiwan, Republic of China.
authors.forename: Hsiao-Yu
authors.initials: HY
authors.lastname: Yang
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
authors.forename: Tsai-Chang
authors.initials: TC
authors.lastname: Lo
authors.forename: Pau-Chung
authors.initials: PC
authors.lastname: Chen
mesh_terms: D000328:Adult; D034341:Aristolochic Acids / Q000009:adverse effects*; D044466:Asian People; D002295:Carcinoma, Transitional Cell / Q000139:chemically induced* / Q000453:epidemiology; D016022:Case-Control Studies; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D029001:Herbal Medicine; D006801:Humans; D008297:Male; D009784:Occupational Diseases / Q000139:chemically induced* / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D034341:Aristolochic Acids; D004365:Drugs, Chinese Herbal