title: Arsenic, tobacco smoke, and occupation: associations of multiple agents with lung and bladder cancer.
abstract: BACKGROUND
  Millions of people worldwide are exposed to arsenic in drinking water, and many are likely coexposed to other agents that could substantially increase their risks of arsenic-related cancer.
  
  
  METHODS
  We performed a case-control study of multiple chemical exposures in 538 lung and bladder cancer cases and 640 controls in northern Chile, an area with formerly high drinking water arsenic concentrations. Detailed information was collected on lifetime arsenic exposure, smoking, secondhand smoke, and other known or suspected carcinogens, including asbestos, silica, and wood dust.
  
  
  RESULTS
  Very high lung and bladder cancer odds ratios (ORs), and evidence of greater than additive effects, were seen in people exposed to arsenic concentrations >335 µg/L and who were tobacco smokers (OR = 16, 95% confidence interval = 6.5-40 for lung cancer; and OR = 23 [8.2-66] for bladder cancer; Rothman Synergy Indices = 4.0 [1.7-9.4] and 2.0 [0.92-4.5], respectively). Evidence of greater than additive effects were also seen in people coexposed to arsenic and secondhand tobacco smoke and several other known or suspected carcinogens, including asbestos, silica, and wood dust.
  
  
  CONCLUSIONS
  These findings suggest that people coexposed to arsenic and other known or suspected carcinogens have very high risks of lung or bladder cancer.
authors.affiliation: From the aDepartamento de Salud Pública, Universidad Católica de Chile, Santiago, Chile; bArsenic Research Group, School of Public Health, University of California, Berkeley, CA; and cHospital de Antofagasta, Antofagasta, Chile.
authors.forename: Catterina
authors.initials: C
authors.lastname: Ferreccio
authors.forename: Yan
authors.initials: Y
authors.lastname: Yuan
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Calle
authors.forename: Hugo
authors.initials: H
authors.lastname: Benítez
authors.forename: Roxana L
authors.initials: RL
authors.lastname: Parra
authors.forename: Johanna
authors.initials: J
authors.lastname: Acevedo
authors.forename: Allan H
authors.initials: AH
authors.lastname: Smith
authors.forename: Jane
authors.initials: J
authors.lastname: Liaw
authors.forename: Craig
authors.initials: C
authors.lastname: Steinmaus
mesh_terms: D000328:Adult; D000368:Aged; D001151:Arsenic / Q000032:analysis / Q000633:toxicity*; D002273:Carcinogens / Q000633:toxicity*; D016022:Case-Control Studies; D002677:Chile / Q000453:epidemiology; D060766:Drinking Water / Q000737:chemistry; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D002273:Carcinogens; D060766:Drinking Water; D014028:Tobacco Smoke Pollution; D001151:Arsenic
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