title: Association of total cancer and lung cancer with environmental exposure to cadmium: the meta-analytical evidence.
abstract: BACKGROUND
  Recent studies are indicative of substantial progress in understanding the dose-response relation between the incidence of total and lung cancer and environmental cadmium exposure. We conducted a meta-analysis of population studies that examined the risk of cancer in relation to lifetime exposure to cadmium.
  
  
  METHODS
  We searched MEDLINE, Web of Science, and relevant reviews until August 2014 for studies on the association between cancer risk and cadmium exposure. Eligible studies had to include an estimate of lifetime exposure to cadmium as reflected by the urinary cadmium concentration and adjustment of the cancer risk at least for age and smoking. We pooled relative risk across the studies estimates for cancer and lung cancer using variance-weighted random-effect models and expressed association sizes for a twofold increase in urinary cadmium, thereby respecting the continuous nature of the association.
  
  
  RESULTS
  The meta-analysis included 20,459 participants from three prospective population studies. The average urinary cadmium concentration across populations ranged from 0.25 to 0.93 µg/g creatinine. The relative risk of total cancer, associated with a doubling of the urinary cadmium concentration, ranged across the different studies from 1.18 to 1.31, and the pooled relative risk was 1.22 (95% CI 1.13-1.31; p < 0.0001). For lung cancer, the relative risk ranged from 1.21 to 1.70 for a doubling of the urinary cadmium concentration, while the pooled relative risk amounted to 1.68 (1.47-1.92; p < 0.0001). Excluding one study at the time did not move the pooled estimates outside the confidence interval of the overall estimate for all studies combined.
  
  
  CONCLUSIONS
  The epidemiological evidence of the last decade consistently identifies low-level environmental exposure to cadmium as a risk factor for total cancer and lung cancer.
authors.affiliation: Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium, tim.nawrot@uhasselt.be.
authors.forename: Tim S
authors.initials: TS
authors.lastname: Nawrot
authors.forename: Dries S
authors.initials: DS
authors.lastname: Martens
authors.forename: Azusa
authors.initials: A
authors.lastname: Hara
authors.forename: Michelle
authors.initials: M
authors.lastname: Plusquin
authors.forename: Jaco
authors.initials: J
authors.lastname: Vangronsveld
authors.forename: Harry A
authors.initials: HA
authors.lastname: Roels
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D002104:Cadmium / Q000009:adverse effects* / Q000652:urine; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000652:urine; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology* / Q000652:urine; D011446:Prospective Studies; D012306:Risk
chemical_list: D002104:Cadmium