Death rates from lung and bladder cancer remained high decades after residents in northern Chile were exposed to high levels of arsenic in their drinking water, according to a new study by researchers from the University of California, Berkeley, and the Pontificia Universidad Católica de Chile in Santiago.
That the mortality risks remained elevated long after exposure to high levels of arsenic ended indicates a clear pattern of latency in health effects that had not been known before, said the authors of the study, which appeared in the June 12 issue of the Journal of the National Cancer Institute.
"The impact of this environmental health risk on cancer mortality in a human population is without precedent," said Allan Smith, professor of epidemiology at UC Berkeley's School of Public Health and principal investigator of the study. "This study adds to the overall body of evidence of the harmful effects of arsenic."
Smith, head of UC Berkeley's Arsenic Health Effects Research Program, worked with Guillermo Marshall, professor and dean of the Faculty of Mathematics at Chile's Pontificia Universidad Católica and lead author of this publication.
Arsenic, a known carcinogen, is a semi-metal element that occurs naturally, with some regions containing higher levels than others. Until recently, the maximum level of arsenic allowed in community water systems in much of the world, including the United States, was 50 micrograms per liter.
Studies - including some by Smith - have shown that arsenic causes lung, bladder and skin cancers. Additional evidence has also linked arsenic with other cancers, including those of the kidney and liver. As a result, the U.S. Environmental Protection Agency lowered the maximum contaminant level for municipal water supplies to 10 micrograms per liter, effective January 2006, the same standard recommended by the World Health Organization.
For 15 years, Smith has been studying Region II of Chile, a northern province that gets its water from arsenic-contaminated rivers originating from the Andes mountains. The municipal water supply of Antofagasta, the region's largest city, and neighboring communities contained about 90 micrograms per liter of inorganic arsenic up until 1958, when government officials sought out additional sources of water to supply the region's growing population. Because there is so little rainfall in the region, considered one of the driest in the world, residents rely almost exclusively on municipal water supplies.
Unfortunately, the supplemental water came from the Toconce and Holajar rivers, which contained even higher levels of arsenic. From 1958 to 1970, water to Antofagasta and the nearby city of Mejillones averaged 870 micrograms per liter, nearly 90 times higher than today's WHO standard. In 1971, the first large-scale arsenic removal plant in the world was installed in Antofagasta, but by then, residents had been exposed to high levels of arsenic for 13 years.
With further improvements to the water treatment system, the arsenic concentration steadily dropped over the years, reaching levels below 50 micrograms per liter after 1990. The recent addition of treated seawater has further reduced arsenic levels to around 10 micrograms per liter in the city water supply.
The well-defined arsenic exposures in Region II in Chile provided researchers with a uniquely large population in which to base their studies.
Prior research led by Smith has confirmed higher rates of lung and bladder cancer deaths for Region II compared with the rest of Chile. What was not known until this study was the latency period between the onset and reductions in exposure, and the subsequent rise and fall in cancer rates.
To get that information, researchers analyzed data from lung and bladder cancer deaths from 1950 to 2000 in Region II, and compared it with Region V, another area in northern Chile with a socio-demographically similar population, but one that had not been exposed to high levels of arsenic.
They found that lung and bladder cancer mortality rates in Region II started to increase in 1968, 10 years after the area's jump in arsenic levels. The mortality rates continued to rise, peaking between 1986 and 1997. Between 1992-1994, more than 20 years after the arsenic levels began dropping, combined lung and bladder cancer death rates were 153 per 100,000 men and 50 per 100,000 women in Region II. Those figures are 2.5 to nearly three times higher than their counterparts in Region V.
"The results show that the risks of concentrated arsenic exposure are extraordinarily high, and that they last a very long time, both after initial exposure, and after the exposure ends," said Smith.
Smith said the study supports the need for more testing of the world's water sources. In the United States, many areas in California, Nevada, Alaska, Michigan, New England, New Mexico and Utah have arsenic levels exceeding 10 micrograms per liter standard in the ground water. Municipal water supplies are tested and treated for arsenic, but Smith pointed out that there are possibly millions of Americans - and vastly more worldwide - drinking arsenic contaminated water from private wells. He argued that every well in the world used to obtain drinking water should be tested for arsenic.
"Unlike contamination by pathogens that may cause an acute outbreak, the effects of drinking arsenic take years to decades to appear," said Smith. "Because there is no odor, color or taste to arsenic-contaminated water, it's hard to convince people that they're at risk."
Co-authors of the study are Catterina Ferreccio of the Pontificia Universidad Católica de Chile; and Yan Yuan, Michael Bates, Craig Steinmaus, Steve Selvin and Jane Liaw from UC Berkeley's School of Public Health.
The work was supported by the National Institute of Environmental Health Sciences and the UC Center for Occupational and Environmental Health.
Materials provided by University of California - Berkeley. Note: Content may be edited for style and length.
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