Mostafa Mohammad Golam, Queen Zarat Jahin, Cherry Nicola
National Institute of Cancer Research and Hospital, Dhaka 1206, Bangladesh.
Manchester Medical School, University of Manchester, Manchester M13 9PL, UK.
Int J Environ Res Public Health. 2017 Oct 6;14(10):1185. doi: 10.3390/ijerph14101185.
Arsenic in drinking water is causally linked with cancer of the skin, lung, and urinary bladder, but there is very little data on a possible role for arsenic in the etiology of cervical cancer, a disease in which human papilloma virus is held to be a necessary but not sufficient cause. All histopathology results from cervical specimens from the National Institute of Cancer Research and Hospital (NICRH), Dhaka (1997-2015), and the Anowara Medical Services (2003-2015), both serving the whole of Bangladesh, were classified by cell type. Arsenic concentrations in well water in the thana of residence were estimated from systematic sampling carried out by the British Geological Survey. In a case-referent analysis arsenic estimates for cases of cervical cancer were compared with those found to have benign lesions. In this study, 3464 NICRH (CH) cervical specimens and 30,050 community medical service (CMS) specimens were available: 3329 (CH) and 899 (CMS) were recorded as malignant. Most were squamous cell carcinoma, of which 4.9% were poorly differentiated. Overall, there was no increase in cervical cancer with increasing arsenic concentration. Among those with squamous cell histology, a strong dose response was seen for poorly differentiated cancer with increasing arsenic exposure. The odds ratio increased monotonically, compared with exposure <10 μg/L, from 1.58 at 10 < 50 μg/L to 8.11 at >200 μg/L (p < 0.001). Given the high proportion of Bangladeshis using drinking water containing >50 μg/L of arsenic, the evidence that arsenic is implicated in cancer grade suggests a need for further investigation and the introduction of cervical screening in high arsenic areas.
饮用水中的砷与皮肤癌、肺癌和膀胱癌存在因果联系，但关于砷在宫颈癌病因学中可能发挥的作用的数据却非常少。宫颈癌被认为人乳头瘤病毒是必要但非充分病因。达卡国家癌症研究与医院（NICRH，1997 - 2015年）以及阿诺瓦拉医疗服务中心（2003 - 2015年）提供服务于整个孟加拉国，这两个机构提供的宫颈标本的所有组织病理学结果均按细胞类型进行了分类。居住乡井水的砷浓度是根据英国地质调查局进行的系统采样估算得出的。在一项病例对照分析中，将宫颈癌病例的砷含量估计值与那些有良性病变者的砷含量估计值进行了比较。在本研究中，有3464份NICRH（CH）宫颈标本和30,050份社区医疗服务（CMS）标本：其中3329份（CH）和899份（CMS）被记录为恶性。大多数是鳞状细胞癌，其中4.9%为低分化癌。总体而言，宫颈癌发病率并未随着砷浓度的升高而增加。在鳞状细胞组织学类型的患者中，随着砷暴露量增加，低分化癌呈现出强烈的剂量反应关系。与砷暴露量<10μg/L相比，比值比呈单调增加，从砷暴露量在10 - 50μg/L时的1.58增加到>200μg/L时的8.11（p<0.001）。鉴于孟加拉国使用含砷量>50μg/L饮用水的人口比例很高，砷与癌症分级有关的证据表明需要进一步调查，并在高砷地区引入宫颈癌筛查。
