title: Use of arsenic-induced palmoplantar hyperkeratosis and skin cancers to predict risk of subsequent internal malignancy.
abstract: Hyperpigmentation, hyperkeratoses, and Bowen's disease are hallmarks of chronic arsenic exposure. The association between arsenic-induced skin lesions and subsequent internal cancers is examined by using a community-based prospective study. The cohort was enrolled from an arseniasis-endemic area in southwestern Taiwan, where 2,447 residents participated in skin examinations during the late 1980s. The number of participants diagnosed with hyperpigmentation was 673; with hyperkeratosis, 243; and with skin cancer (Bowen's disease or non-melanoma skin cancer), 378. Newly diagnosed internal cancers were ascertained through linkage with National Cancer Registry profiles. Cox regression was performed to estimate hazard ratios with 95% confidence intervals for potential risk predictors. Compared with participants without skin lesions, patients affected with skin cancers had a significantly increased risk of lung cancer (hazard ratio = 4.64, 95% confidence interval: 2.92, 7.38) and urothelial carcinoma (hazard ratio = 2.02, 95% confidence interval: 1.23, 3.30) after adjustment for potential confounders and cumulative arsenic exposure. Hyperkeratosis is significantly associated with an increased lung cancer risk (hazard ratio = 2.76, 95% confidence interval: 1.35, 5.67). A significant interactive effect on lung cancer risk between hyperkeratosis and cigarette smoking was identified, which suggests that patients with hyperkeratosis who have been exposed to arsenic should cease smoking.
authors.affiliation: Genomics Research Center, Academia Sinica, Taipei, Taiwan. hsu277@gmail.com
authors.forename: Ling-I
authors.initials: LI
authors.lastname: Hsu
authors.forename: Gwo-Shing
authors.initials: GS
authors.lastname: Chen
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Lee
authors.forename: Tse-Yen
authors.initials: TY
authors.lastname: Yang
authors.forename: Yu-Hsin
authors.initials: YH
authors.lastname: Chen
authors.forename: Yuan-Hung
authors.initials: YH
authors.lastname: Wang
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Hsueh
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
authors.forename: Meei-Maan
authors.initials: MM
authors.lastname: Wu
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D020261:Arsenic Poisoning / Q000453:epidemiology*; D001913:Bowen's Disease / Q000139:chemically induced / Q000453:epidemiology; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced / Q000453:epidemiology; D007645:Keratoderma, Palmoplantar / Q000139:chemically induced* / Q000453:epidemiology; D008175:Lung Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000139:chemically induced / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012878:Skin Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D013624:Taiwan / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced / Q000453:epidemiology; D014874:Water Pollutants, Chemical / Q000506:poisoning*
chemical_list: D014874:Water Pollutants, Chemical