Bladder Cancer Clusters in Florida: Identifying Populations at Risk
ABSTRACT Modifiable risk factors for bladder cancer have been identified, ie tobacco and chemical exposure. We identified high risk bladder cancer areas and risk factors associated with bladder cancer clusters in Florida using individual and area based data.
Spatial modeling was applied to 23,266 early and advanced bladder cancer cases diagnosed between 1998 and 2002 in Florida to identify areas of excess bladder cancer risk. Multivariable regression was used to determine whether sociodemographic indicators, smoking history and proximity to known arsenic contaminated drinking water well sites were associated with bladder cancer diagnosis in a specific area (cluster).
A total of 25 clusters were found to have a higher than expected bladder cancer rate, including 13 and 12 of early and late stage disease, respectively. Urban white patients were more likely to live in an advanced bladder cancer cluster. Advanced bladder cancer cluster membership was associated with living in close proximity to known arsenic contaminated drinking water wells.
There are multiple areas of early and late stage bladder cancer clusters in Florida. Individuals in an advanced bladder cancer cluster tended to live close to arsenic contaminated wells. Increased evaluation of potentially contaminated well water is warranted in these high risk areas. Targeted bladder cancer public awareness campaigns, smoking cessation support and potentially targeted screening should also be considered in communities at increased risk for bladder cancer. Our analytical approach can also be used by others to systematically identify communities at high risk for bladder and other cancers.
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- "In Bangladesh, more than 70 million people are at risk of long term exposure to high levels of arsenic through groundwater . On the other hand, chronic exposure to low-levels of arsenic in drinking water is an emerging risk across different parts of the world, including North America (Figure 1) [4-7]. Paradoxically, arsenic (as arsenic trioxide, A2O3) is also used as therapeutic agent in the treatment of acute promyelocytic leukemia [8,9]. "
ABSTRACT: Arsenic is a well-known human carcinogen, which potentially affects ~160 million people worldwide via exposure to unsafe levels in drinking water. Lungs are one of the main target organs for arsenic-related carcinogenesis. These tumors exhibit particular features, such as squamous cell-type specificity and high incidence among never smokers. Arsenic-induced malignant transformation is mainly related to the biotransformation process intended for the metabolic clearing of the carcinogen, which results in specific genetic and epigenetic alterations that ultimately affect key pathways in lung carcinogenesis. Based on this, lung tumors induced by arsenic exposure could be considered an additional subtype of lung cancer, especially in the case of never-smokers, where arsenic is a known etiological agent. In this article, we review the current knowledge on the various mechanisms of arsenic carcinogenicity and the specific roles of this metalloid in signaling pathways leading to lung cancer.Molecular Cancer 03/2013; 12(1):20. DOI:10.1186/1476-4598-12-20 · 4.26 Impact Factor
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- "Finally, a case–control study drawn from residents of New Hampshire and Vermont found that arsenic exposure was associated with risk of small-cell and squamous-cell carcinoma of the lung (2.75; 1.0- 7.57) among those with toenail arsenic concentration > 0.114 ug/g versus < 0.05 ug/g . In Florida, clusters of bladder cancer were found among those who live in close proximity to known arsenic-contaminated drinking water wells . "
ABSTRACT: We sought to identify high-risk areas of pancreatic cancer incidence, and determine if clusters of persons diagnosed with pancreatic cancer were more likely to be located near arsenic-contaminated drinking water wells. A total of 5,707 arsenic samples were collected from December 2000 to May 2008 by the Florida Department of Health, representing more than 5,000 individual privately owned wells. During that period, 0.010 ppm (10 ppb) or greater arsenic levels in private well water were considered as the threshold based on standard of United States Environmental Protection Agency (EPA). Spatial modeling was applied to pancreatic cancer cases diagnosed between 1998-2002 in Florida (n = 11,405). Multivariable logistic regression was used to determine if sociodemographic indicators, smoking history, and proximity to arsenic-contaminated well sites were associated with residence at the time of pancreatic cancer diagnosis occurring within versus outside a cluster. Spatial modeling identified 16 clusters in which 22.6% of all pancreatic cancer cases were located. Cases living within 1 mile of known arsenic-contaminated wells were significantly more likely to be diagnosed within a cluster of pancreatic cancers relative to cases living more than 3 miles from known sites (odds ratio = 2.1 [95% CI = 1.9, 2.4]). Exposure to arsenic-contaminated drinking water wells may be associated with an increased risk of pancreatic cancer. However, case-control studies are needed in order to confirm the findings of this ecological analysis. These cluster areas may be appropriate to evaluate pancreatic cancer risk factors, and to perform targeted screening and prevention studies.BMC Cancer 03/2013; 13(1):111. DOI:10.1186/1471-2407-13-111 · 3.36 Impact Factor
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ABSTRACT: Smoking, inadequate vitamin D and pesticide exposure have been linked to bladder cancer (BCa) in past studies. The objective of this study is to explore associations between BCa rates and these risk factors. BCa incidence and mortality rates among states were compared to smoking; solar ultraviolet (UV) radiation levels and drinking water from a surface water supply (which has greater residual pesticide contamination than groundwater and both are used as sources for drinking water). Lack of health insurance, median family income and urbanization were included to adjust for access to health care and socioeconomic status. BCa incidence and mortality correlated directly with smoking and inversely with solar UV radiation for males and females. BCa mortality correlated directly with drinking surface water for both sexes. Lack of health insurance correlated inversely with BCa incidence for females and trended toward significance for males. Multivariable analyses identified solar UV radiation as the best predictor of BCa incidence in males and solar UV radiation and smoking in females. Solar UV radiation, smoking and drinking surface water were the best predictors of BCa mortality in males, while smoking and drinking surface water were the best predictors of mortality in females. BCa incidence and mortality for both sexes correlated directly with smoking and inversely with solar UV radiation levels. BCa mortality for both sexes correlated with drinking water from a surface water source. It is hypothesized that BCa mortality risks may increase from drinking water contaminated with low levels of pesticides.International Urology and Nephrology 10/2009; 42(3):659-65. DOI:10.1007/s11255-009-9655-5 · 1.52 Impact Factor