title: Elevated Bladder Cancer in Northern New England: The Role of Drinking Water and Arsenic.
abstract: Bladder cancer mortality rates have been elevated in northern New England for at least five decades. Incidence rates in Maine, New Hampshire, and Vermont are about 20% higher than the United States overall. We explored reasons for this excess, focusing on arsenic in drinking water from private wells, which are particularly prevalent in the region.
  
  
  
  In a population-based case-control study in these three states, 1213 bladder cancer case patients and 1418 control subjects provided information on suspected risk factors. Log transformed arsenic concentrations were estimated by linear regression based on measurements in water samples from current and past homes. All statistical tests were two-sided.
  
  
  
  Bladder cancer risk increased with increasing water intake (Ptrend = .003). This trend was statistically significant among participants with a history of private well use (Ptrend = .01). Among private well users, this trend was apparent if well water was derived exclusively from shallow dug wells (which are vulnerable to contamination from manmade sources, Ptrend = .002) but not if well water was supplied only by deeper drilled wells (Ptrend = .48). If dug wells were used pre-1960, when arsenical pesticides were widely used in the region, heavier water consumers (>2.2 L/day) had double the risk of light users (<1.1 L/day, Ptrend = .01). Among all participants, cumulative arsenic exposure from all water sources, lagged 40 years, yielded a positive risk gradient (Ptrend = .004); among the highest-exposed participants (97.5th percentile), risk was twice that of the lowest-exposure quartile (odds ratio = 2.24, 95% confidence interval = 1.29 to 3.89).
  
  
  
  Our findings support an association between low-to-moderate levels of arsenic in drinking water and bladder cancer risk in New England. In addition, historical consumption of water from private wells, particularly dug wells in an era when arsenical pesticides were widely used, was associated with increased bladder cancer risk and may have contributed to the New England excess.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ). dalsubaris@gmail.com silvermd@mail.nih.gov.
authors.forename: Dalsu
authors.initials: D
authors.lastname: Baris
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Richard
authors.initials: R
authors.lastname: Waddell
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Laura E
authors.initials: LE
authors.lastname: Beane Freeman
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Molly
authors.initials: M
authors.lastname: Schwenn
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Joanne S
authors.initials: JS
authors.lastname: Colt
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Ayotte
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Mary H
authors.initials: MH
authors.lastname: Ward
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: John
authors.initials: J
authors.lastname: Nuckols
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Alan
authors.initials: A
authors.lastname: Schned
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Brian
authors.initials: B
authors.lastname: Jackson
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Castine
authors.initials: C
authors.lastname: Clerkin
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Rothman
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Lee E
authors.initials: LE
authors.lastname: Moore
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Gilpin
authors.initials: G
authors.lastname: Robinson
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Gm Monawar
authors.initials: GM
authors.lastname: Hosain
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Karla R
authors.initials: KR
authors.lastname: Armenti
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Richard
authors.initials: R
authors.lastname: McCoy
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Claudine
authors.initials: C
authors.lastname: Samanic
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hoover
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Fraumeni
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Alison
authors.initials: A
authors.lastname: Johnson
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ).
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Karagas
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, Bethesda, MD (DB [formerly], LEBF, JSC, MHW, NR, LEM, CS [formerly], RNH, JFF, DTS); Geisel School of Medicine at Dartmouth, Hanover, NH (RW, AS, MRK); Maine Cancer Registry, Augusta, ME (MS, CC [formerly]); US Geological Survey, Pembroke, NH (JA), Reston, VA (GR); Colorado State University, Fort Collins, CO (JN); Dartmouth College, Hanover, NH (BJ); Information Management Services, Calverton, MD (AT); New Hampshire State Cancer Registry, Concord, NH (GMH); New Hampshire State Occupational Surveillance Program, Concord, NH (KRA); Vermont Department of Health, Burlington, VT (RM, AJ). dalsubaris@gmail.com silvermd@mail.nih.gov.
authors.forename: Debra T
authors.initials: DT
authors.lastname: Silverman
mesh_terms: D000328:Adult; D000368:Aged; D001151:Arsenic / Q000032:analysis*; D016022:Case-Control Studies; D004326:Drinking; D060766:Drinking Water / Q000737:chemistry*; D005260:Female; D006801:Humans; D015994:Incidence; D008281:Maine / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009513:New Hampshire / Q000453:epidemiology; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000401:mortality; D014707:Vermont / Q000453:epidemiology; D060986:Water Wells
chemical_list: D060766:Drinking Water; D001151:Arsenic