title: Association between levels of urinary heavy metals and increased risk of urothelial carcinoma.
abstract: OBJECTIVE
  To evaluate possible sources of exposure to heavy metals in the general population, and to determine the association between urinary heavy metals and urothelial carcinoma risk.
  
  
  METHODS
  We recruited 205 patients with urothelial carcinoma and 406 control participants for a case-control study between June 2011 and December 2013. The control participants were frequency-matched with cases according to sex and age. We measured the urinary levels of arsenic, cadmium, chromium, nickel and lead by using inductively coupled plasma mass spectrometry. We collected environmental exposure-related information through questionnaires. Multivariate logistic regression and 95% confidence intervals were applied to estimate the urothelial carcinoma risk and potential effects of urothelial carcinoma-related risk factors on the levels of urinary heavy metals.
  
  
  RESULTS
  Patients with urothelial carcinoma showed higher urinary levels of arsenic, cadmium, chromium, nickel and lead than the controls. After considering other potential risk factors, a significantly increased risk for urothelial carcinoma was observed in patients with increased urinary levels of cadmium, chromium, nickel and lead. Smokers showed a high urinary cadmium level. In addition to cadmium, a high urinary lead level was associated with cumulative cigarette smoking and herbal medicine use.
  
  
  CONCLUSIONS
  Environmental factors might contribute to higher urinary levels of heavy metals and ultimately result in urothelial carcinoma carcinogenesis. These findings can promote proper environmental surveillance of exposure to heavy metals in the general population.
authors.affiliation: Department of Medicine, China Medical University and Hospital, Taichung, Taiwan.|Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chao-Hsiang
authors.initials: CH
authors.lastname: Chang
authors.affiliation: Department of Medicine, China Medical University and Hospital, Taichung, Taiwan.|Department of Family Medicine, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chiu-Shong
authors.initials: CS
authors.lastname: Liu
authors.affiliation: Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
authors.forename: Huei-Ju
authors.initials: HJ
authors.lastname: Liu
authors.affiliation: Department of Urology, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chi-Ping
authors.initials: CP
authors.lastname: Huang
authors.affiliation: Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chao-Yuan
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Hui-Tsung
authors.initials: HT
authors.lastname: Hsu
authors.affiliation: Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
authors.forename: Saou-Hsing
authors.initials: SH
authors.lastname: Liou
authors.affiliation: Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D063646:Carcinogenesis / Q000139:chemically induced; D002295:Carcinoma, Transitional Cell / Q000453:epidemiology*; D016022:Case-Control Studies; D004781:Environmental Exposure; D004784:Environmental Monitoring; D004785:Environmental Pollutants / Q000652:urine*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D019216:Metals, Heavy / Q000652:urine*; D008875:Middle Aged; D015999:Multivariate Analysis; D016273:Occupational Exposure; D028321:Plant Preparations / Q000009:adverse effects / Q000737:chemistry; D012307:Risk Factors; D012907:Smoking / Q000652:urine; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology; D014571:Urologic Neoplasms / Q000453:epidemiology*
chemical_list: D004785:Environmental Pollutants; D019216:Metals, Heavy; D028321:Plant Preparations
keywords: cadmium; chromium; lead; nickel; urothelial carcinoma