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.
Epidemiology. 2013 Nov;24(6):898-905. doi: 10.1097/EDE.0b013e31829e3e03.
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.
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.
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.
These findings suggest that people coexposed to arsenic and other known or suspected carcinogens have very high risks of lung or bladder cancer.
全世界数百万人的饮用水中含有砷，许多人可能同时接触到其他可能大大增加其砷相关性癌症风险的物质。
我们在智利北部进行了一项涉及多种化学暴露的病例对照研究，该地区曾有高浓度的饮用水砷。详细收集了一生中砷暴露、吸烟、二手烟以及其他已知或疑似致癌物质（包括石棉、二氧化硅和木尘）的信息。
在接触浓度>335μg/L 砷且吸烟的人群中，肺癌和膀胱癌的比值比（OR）非常高，且存在相加作用（OR=16，95%置信区间=6.5-40；OR=23 [8.2-66]，膀胱癌；Rothman 协同指数=4.0 [1.7-9.4]和 2.0 [0.92-4.5]）。在接触砷和二手烟草烟雾以及其他几种已知或疑似致癌物质（包括石棉、二氧化硅和木尘）的人群中，也存在相加作用的证据。
这些发现表明，同时接触砷和其他已知或疑似致癌物质的人群，患肺癌或膀胱癌的风险非常高。
