Reduced burden of Arsenic-Related cancers after water mitigation in Taiwan

• Published in: Environment international Vol. 185; p. 108542
• Main Authors: Jhuang, Jing-Rong, Lee, Chih-Hung, Chiang, Chun-Ju, Chen, Chien-Jen, Lee, Wen-Chung
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2024; Elsevier
• Subjects: Age-period-cohort analysis; Arsenic - analysis; Arsenic mitigation; Bowen's Disease; Cancer incidence; Carcinoma, Hepatocellular; Carcinoma, Transitional Cell; Drinking Water; Humans; Liver Neoplasms; Lung Neoplasms - epidemiology; Skin Neoplasms - epidemiology; Taiwan - epidemiology; Urinary Bladder Neoplasms - epidemiology; Water Pollutants, Chemical; Water Supply; Taiwan; Drinking water; Cancer incidence; Arsenic mitigation; Age-period-cohort analysis
• ISSN: 0160-4120; 1873-6750
• DOI: 10.1016/j.envint.2024.108542

[Display omitted] •This study scrutinizes the correlation between arsenic mitigation via tap water supply system installation in Blackfoot disease-endemic regions of Taiwan and the reduction in incidence rates of six arsenic-related cancers from 1995 to 2019.•Utilizing the Taiwan Cancer Registry dataset and employing random-effects age-period-cohort models and stabilized kriging method, the analysis reveals a consistent higher incidence of these cancers in Blackfoot disease-endemic areas, with a noticeable narrowing of incidence rates gap post-arsenic mitigation (initiated around 1960).•Notably, three cancers - small and squamous cell lung cancer, Bowen’s disease, and urothelial bladder cancer showed a sharp decline to null excess incidence rates for individuals born post-mitigation, contrasting with a more gradual decline observed in upper tract urothelial carcinoma.•Spatiotemporal analysis identifies high incidence rate clusters in core Blackfoot disease-endemic townships, dissipating primarily post-1960 birth cohort, alongside other identified clusters in non-endemic regions.•The study substantiates the positive impact of arsenic mitigation on reducing the burden of arsenic-related cancers, albeit at varying rates across different cancer types, shedding light on the significance of environmental interventions in public health enhancement.•The findings also allude to the potential influence of other factors such as tobacco control and aristolochic acid prohibition in the observed cancer incidence trends, emphasizing a multifaceted approach in cancer prevention and control. Epidemiological evidence has demonstrated an association between arsenic in drinking water and increased cancer incidence. This population-based study investigates the impact of a tap water supply system installation in Blackfoot disease-endemic regions of Taiwan on cancer incidence. By using the Taiwan Cancer Registry dataset, we enrolled patients aged 40–84 diagnosed with arsenic-related cancers, including hepatocellular carcinoma, small and squamous cell lung cancer, Bowen’s disease, basal and squamous cell skin cancer, urothelial bladder cancer, and upper tract urothelial carcinoma between 1995 and 2019. Random-effects age-period-cohort models were used to estimate the cancer incidence data, and a stabilized kriging method was employed to interpolate incidence rates to more precise spatiotemporal units. The results showed that the age-standardized incidence rates of all six types of studied cancers were consistently higher in Blackfoot disease-endemic areas than those in other areas from 1995 to 2019. However, the gap in incidence rates between Blackfoot disease-endemic areas and the remaining regions began to narrow approximately after the 1960 birth cohort when the tap water supply system installation commenced. For small and squamous cell lung cancer, Bowen’s disease, and urothelial bladder cancer, the excess incidence rates sharply declined to null for those born after the year of arsenic mitigation. For upper tract urothelial carcinoma, the excess incidence rates decreased more gradually for those born after the year of arsenic mitigation. For hepatocellular carcinoma and basal and squamous cell skin cancer, the excess incidence rates remained constant. Spatiotemporal clusters of high incidence rates were identified in the core townships of Blackfoot disease-endemic areas. These clusters began to dissipate mainly after the 1960 birth cohort. Arsenic mitigation from drinking water in Taiwan is associated with a reduced burden of small and squamous cell lung cancers, Bowen’s disease, urothelial bladder cancer, and upper tract urothelial carcinoma.