Arsenic Ingestion and Bladder Cancer Mortality—What Do the Dose-Response Relationships Suggest About Mechanism?

ABSTRACT The Black–Foot Disease (BFD) endemic area of SW Taiwan has historically been the principal data source for assessing cancer risks from arsenic in drinking water in the United States, most recently in a 42–village ecological study. The data showed a discontinuity for bladder cancer risk at about 400 μg/L. A proposed explanation was that the arsenic–dependent bladder cancer risk was found only for those villages that were dependent on water from the artesian well aquifer (As > 350 μg/L and co–contamination with humic acids) and not for those villages receiving water from the shallow aquifer (As < 350 μg/L without humic acids). The humic acids were present from the algae that grew in the uncovered tanks holding the artesian water. The risk factors (slopes) developed from these subpopulations of the SW Taiwan study were applied to the data from an ecological study of median groundwater arsenic concentration and bladder cancer mortality in 133 U.S. counties dependent on groundwater to determine the sl...