Relation of arsenic exposure to lung cancer among tin miners in Yunnan Province, China

Synergy of arsenic with smoking in causing cardiovascular disease mortality: A cohort study with 27 follow-up years in China

Background

To explore the patterns of the exposure-response relationship between arsenic exposure and cardiovascular disease (CVD) mortality and investigate the effect of cigarette smoking on the association.

Methods

Seven thousand seven hundred thirty-five tin miners with at least 10 years of arsenic exposure were enrolled since 1992 and followed up for 27 years. Each individual's air arsenic exposure at workplace was calculated by time weighted average arsenic concentration × exposure months. Detailed information on smoking was collected at baseline, and information on smoking status was collected for five consecutive years from 1992 to 1996. Hazard ratio (HR) and 95% confidence interval (CI) for the risk of CVD were estimated using Cox proportional hazards models.

Results

A total of 1,046 CVD deaths occurred in this cohort over 142,287.7 person-years of follow up. We firstly reported that for equal cumulative exposure, participants exposed to higher concentrations over shorter duration had a higher risk of CVD mortality than those exposed to lower concentration over longer duration. The HR and 95% CI were 1.38 (95%CI: 1.03-1.85) in participants exposed to arsenic concentration (45.5-99.5 mg/m³), 1.29 (95%CI: 1.02-1.67) in 99.5-361.0 mg/m³. Further, participants with age at first exposure <18 years had a significantly higher risk of morality from CVD, cerebrovascular and heart diseases than those with ≥18 years. Finally, all synergy indices were greater than 1 (range, 1.11-2.39), indicating that the joint effect of arsenic exposure and cigarette smoking on CVD mortality was greater than the sum of their individual effect.

Conclusions

Exposure to air arsenic at workplace is adversely associated with mortality from CVD, especially among smokers younger than 18 years and smokers.

Effect of Time Since Smoking Cessation on Lung Cancer Incidence: An Occupational Cohort With 27 Follow-Up Years

Background

This special cohort reveals the effect of smoking cessation in occupational miners exposed to radon and arsenic.

Methods

A total of 9,134 tin miners with at least 10 years of underground radon and arsenic exposure were enrolled beginning in 1992 and followed for up to 27 years. Detailed smoking information was collected at baseline, and information on smoking status was consecutively collected from 1992 to 1996. The Cox proportional hazards model was used to explore the relationship between time since smoking cessation and lung cancer.

Results

A total of 1,324 lung cancer cases occurred in this cohort over 167,776 person-years of follow-up. Among populations exposed to radon and arsenic, miners after quitting smoking for 10 years or more had almost halved their lung cancer risk [adjusted hazard ratio (HR) = 0.55, 95% CI: 0.38-0.79], compared with current smokers. Among miners after quitting smoking for 5 years or more, lung cancer incidence approximately halved (HR = 0.52, 95% CI: 0.30-0.92) for squamous cell lung carcinoma, while it showed no significant decline for adenocarcinoma (HR = 0.79, 95% CI: 0.34-1.85).

Conclusion

Smoking cessation for 10 years or more halved lung cancer incidence among miners exposed to radon and arsenic, and the benefit was more pronounced among squamous cell lung carcinoma.

Quantitative evaluation of radon, tobacco use and lung cancer association in an occupational cohort with 27 follow-up years

BACKGROUND

Occupational radon cohorts provide important information about exposure at residential level, which are difficult to observe prospectively. However, evidence about radon-related lung cancer risks from initial exposure in childhood or interaction between radon and smoking is still limited.

METHODS

A total of 6017 tin miners with at least 10 years of underground radon exposure were enrolled beginning in 1992 and followed for up to 27 years. Lung cancer risks were estimated by modeling total and intensity of radon exposure.

RESULTS

A total of 933 lung cancer cases occurred in this cohort over 89,092 person-years of follow up. Excess relative risk increased by 0.96% per cumulative working level month (WLM). A unique aspect of this population was the early age at first radon exposure for workers. Results showed that lung cancer risk from initial radon exposure in childhood (<13 years old) was greater than risk when first exposure occurred at later ages (13-17, 18-24, and ≥ 25 years old). Moreover, risk declined with years since last exposure and attained age, but increased with age at last exposure. Importantly, these patterns were stable after adjustment for tobacco use or arsenic exposure. For joint effects of radon and other agents, our results support sub-multiplicative as the most likely model for interaction between radon and tobacco use or arsenic exposure.

CONCLUSION

This study highlights the possible importance of radon exposure in childhood in cancer etiology and suggests another potential strategy to mitigate the global lung cancer burden.

Unique Profile of Driver Gene Mutations in Patients With Non-Small-Cell Lung Cancer in Qujing City, Yunnan Province, Southwest China

Objective

Qujing City, Yunnan Province, China, has a high incidence of lung cancer and related mortality. The etiology of NSCLC in Qujing area and distribution of associated molecular aberrations has not been fully elucidated. This study aimed to reveal the profile of driver gene mutations in patients with non-small-cell lung cancer (NSCLC) in Qujing and explore their relationships with clinicopathological characteristics.

Methods

In this study, the mutation profiles of NSCLC driver genes, including EGFR, ALK, ROS1, KRAS, BRAF, RET, MET, HER2, NRAS, and PIK3CA, were investigated in patients with NSCLC from Qujing and compared with those from other regions in Yunnan Province. The associations between molecular mutations and clinicopathological characteristics were further analyzed.

Results

A distinct profile of driver gene mutations was discovered in patients with NSCLC from Qujing. Interestingly, a higher proportion of EGFR compound mutations, including G719X + S768I (19.65% vs 3.38%, P < 0.0001) and G719X + L861Q (21.10% vs 2.82%, P < 0.0001), was observed in patients with NSCLC in Qujing compared with patients in non-Qujing area, besides significantly different distributions of EGFR (46.01% vs. 51.07%, P = 0.0125), ALK (3.17% vs. 6.97%, P = 0.0012), ROS1 (0.5% vs. 2.02%, P = 0.0113), and KRAS (23.02% vs. 7.85%, P < 0.0001). Further, EGFR compound mutations were more likely associated with the occupation of patients (living/working in rural areas, e.g., farmers). Moreover, KRAS G12C was the dominant subtype (51.11% vs 25.00%, P = 0.0275) among patients with NSCLC having KRAS mutations in Qujing.

Conclusions

Patients with NSCLC in Qujing displayed a unique profile of driver gene mutations, especially a higher prevalence of EGFR compound mutations and dominant KRAS G12C subtype, in this study, indicating a peculiar etiology of NSCLC in Qujing. Therefore, a different paradigm of therapeutic strategy might need to be considered for patients with NSCLC in Qujing.

Arsenic and arsenic speciation in mushrooms from China: A review

Arsenic (As) is a natural environmental contaminant to which humans are usually exposed in water, air, soil, and food. China is a typical high-As region, and also a great contributor of the world production of cultivated edible mushrooms and a region abundant in wild growing edible mushrooms. Mushrooms can accumulate different amounts of As and different As compounds, so potential health risk of As intake may exist to people who use mushrooms with elevated As contents as food or medicine. A systematic literature search was carried out for studies on As and As compounds in mushrooms from China. We compiled existing data from published sources in English or Chinese and provide an updated review of the findings on As in mushrooms associated with environments and health risks. Future perspectives for studies on As in mushrooms have also been discussed.

Overview of biochar production from preservative-treated wood with detailed analysis of biochar characteristics, heavy metals behaviors, and their ecotoxicity

Concerns over the disposal of preservative-treated wood waste and its related environmental problems are the main driving forces of research into the recycling of preservative-treated wood. Preservative-treated wood waste composed of cellulose, hemicellulose, and lignin with several types of heavy metals can be recycled in various ways, such as wood-based composites, heavy metal extraction, energy recovery, etc. In particular, thermochemical conversion has attracted considerable attention recently because energy can be recovered from biomass as liquid fuel and bio-oil, as well as produce bio-char with a high carbon content, which can be applied to valuable products, such as soil amendment, adsorbents, solid fuels, and catalyst supports. On the other hand, environmental issues, such as heavy metal volatilization and heavy metal leaching, are still a challenge. This review reports the state-of-the-art knowledge of biochar production from preservative-treated wood with the main focus on the feedstock, process technology, biochar characteristics, application, and environmental issues. This review provides important information for future studies into the recycling of preservative-treated woods into biochar.

[Risk Factors of Lung Cancer in Xuanwei, Yunnan Province, China]

BACKGROUND

Since 1970s, Xuanwei in Yunnan province has been one of the towns with highest lung cancer mortality in China. Moreover, the characters of high female lung cancer mortality and sub-regional clustering high lung cancer mortality have not changed. In this study, we further described the exposure situation of risk factors of lung cancer in Xuanwei nowadays, in order to explore the trend of the distribution of lung cancer there.

METHODS

Firstly we divided the 26 towns of Xuanwei city to high-, median- and low- lung cancer areas by the lung cancer mortality in 2010-2012. We chose 2 towns within each area according to topography and orientation, and randomly picked 4 villages in each town to be our study area. We did a questionnaire about lung cancer related risk factors upon the sample population in the study area. We calculated the exposure percentages of each risk factor, in whole sample population and subgroups, for nowadays and for 10 years ago (only living environmental risk factors), and compared them between areas or time points using standardized rates and the statistical test of standardized rate comparison, or chi-square test.

RESULTS

65%-80% male in the study area has a history of smoking; 60%-90% non-smoker has been exposed to second hand smoke. These situations are worse in high and median lung cancer areas. 50% male in median lung cancer area have coal mining work experience, which is 2 times of the percentages in the other two areas; while 15%-25% people in high lung cancer area have other occupational exposure history to particulate air pollution, which is 3-5 times of the percentages in the other two areas. From ten years ago until nowadays, 80% families in median lung cancer area use 2 tons or more smoky coal per year; more than 90% families burn coal for household heating; more than 60% families suffer from smog in the kitchen during cook; 60% families most frequently use stove in the ground with chimney. Only 20% families in high lung cancer area now use 2 tons or more smoky coal per year. Now 50%-75% families in the study area use 700 kilowatt-hours of electricity per year, much more than ten years ago. 80% residents in low lung cancer area eat fatty or pickled or smoked food at least 3 days per week; while in high and median lung cancer areas the percentages are 50%-60%.

CONCLUSIONS

According to data obtained in this survey, current distribution of smoky coal use has differed from the distribution of high-, median- and low- lung cancer areas. Tobacco use and second hand smoke, the use of smoky coal and occupational exposure to particulate matters could be the main risk factors for lung cancer in Xuanwei now. The relations between lung cancer and stove type, dietary habit and so on deserve further study.

A preliminary study for conducting a rational assessment of radon exposure levels

The aim of this study was to determine the factors that go into a highly reliable estimate of radon exposure levels for use in setting up the case-control study. To this end, the present study conducted a multi-faceted investigation of the distribution of radon concentrations in the bedrooms and living rooms of 400 households in the target areas during the winter months from December 2014 to February 2015. We determined that taking the mean value of the radon concentration levels detected in the bedroom and living room as the representative value of residential concentration is appropriate, given the usability of previous research data and the difference in the concentration levels between the two. In terms of detector placement, we found that detectors should not inconvenience residents or be affected by an air current. Further, we found that housing type should distinguish between regular housing (single-detached, row, and multiplex housing) and apartments but that the building type was not a key factor in the assessment of radon exposure levels. Houses should be classified into those constructed with soil (red clay) and those with constructed with general building materials for the assessment of radon exposure levels.

Biological effects and epidemiological consequences of arsenic exposure, and reagents that can ameliorate arsenic damage in vivo

Through contaminated diet, water, and other forms of environmental exposure, arsenic affects human health. There are many U.S. and worldwide "hot spots" where the arsenic level in public water exceeds the maximum exposure limit. The biological effects of chronic arsenic exposure include generation of reactive oxygen species (ROS), leading to oxidative stress and DNA damage, epigenetic DNA modification, induction of genomic instability, and inflammation and immunomodulation, all of which can initiate carcinogenesis. High arsenic exposure is epidemiologically associated with skin, lung, bladder, liver, kidney and pancreatic cancer, and cardiovascular, neuronal, and other diseases. This review briefly summarizes the biological effects of arsenic exposure and epidemiological cancer studies worldwide, and provides an overview for emerging rodent-based studies of reagents that can ameliorate the effects of arsenic exposure in vivo. These reagents may be translated to human populations for disease prevention. We propose the importance of developing a biomarker-based precision prevention approach for the health issues associated with arsenic exposure that affects millions of people worldwide.

Modification of association between prior lung disease and lung cancer by inhaled arsenic: A prospective occupational-based cohort study in Yunnan, China

Arsenic and prior lung diseases have been shown to increase lung cancer risk; however, little is known about their joint effects. The aim of our study was to analyze the joint effects of inhaled arsenic and prior lung diseases on lung cancer risk within a occupational cohort. The interactions of prior lung diseases and inhaled arsenic were analyzed based on multiplicative and additive scales in the Cox proportional hazards model. Compared with low arsenic exposure and no history of asthma, the hazard ratios (HRs) of high arsenic exposure with asthma, high arsenic exposure without asthma and low arsenic exposure with asthma were 2.61 (95% CI: 1.71-4.00), 2.60 (95% CI: 1.93-3.51) and 2.49 (95% CI: 1.53-4.06), respectively. Based on the multiplicative scale in the Cox proportional hazards model, the HR of the interaction of asthma and arsenic on lung cancer risk was 0.45 (95% CI: 0.25-0.80). Based on the additive scale, the relative excess risk due to interaction between asthma and arsenic was -1.41 (95% CI: -2.81 to -0.02). Our study provides strong evidence that arsenic exposure is associated with lung cancer risk. A significant negative interaction between asthma and arsenic on lung cancer risk is observed.

[A cohort study on risk factors of lung cancer in Yunnan tin miners]

背景与目的

吸烟是肺癌的主要病因, 在矿工肺癌病因的研究中发现, 职业暴露因素也起重要作用。本研究旨在分析氡暴露、吸烟等危险因素对云锡矿工肺癌的影响, 为预防和控制肺癌高发提供科学依据。

方法

利用前瞻性队列研究方法, 对云锡矿工肺癌高危人群暴露因素对肺癌死亡的影响进行Cox多因素分析; 分析矿工肺癌危险与初始氡暴露年龄及氡暴露率的关系, 分析不同吸烟、氡暴露水平下肺癌死亡的危险, 并对吸烟和累积氡暴露量之间的交互作用进行分析。

结果

进入研究时的年龄、吸烟量、累积氡砷暴露、既往慢性支气管炎为云锡矿工肺癌的独立危险因素, 教育程度是矿工肺癌的保护性因素; 肺癌危险与氡暴露率间存在逆剂量率效应, 但与初始氡暴露年龄无明显关联; 吸烟和氡暴露对肺癌危险有显著的相加交互作用。

结论

云锡矿工肺癌高死亡率是多种因素共同作用的结果, 危险因素间的交互作用值得进一步深入研究。

Oxidative stress in the carcinogenicity of chemical carcinogens

This review highlights several in vivo studies utilizing non-genotoxic and genotoxic chemical carcinogens, and the mechanisms of their high and low dose carcinogenicities with respect to formation of oxidative stress. Here, we survey the examples and discuss possible mechanisms of hormetic effects with cytochrome P450 inducers, such as phenobarbital, a-benzene hexachloride and 1,1-bis(p-chlorophenyl)-2,2,2-trichloroethane. Epigenetic processes differentially can be affected by agents that impinge on oxidative DNA damage, repair, apoptosis, cell proliferation, intracellular communication and cell signaling. Non-genotoxic carcinogens may target nuclear receptors and induce post-translational modifications at the protein level, thereby impacting on the stability or activity of key regulatory proteins, including oncoproteins and tumor suppressor proteins. We further discuss role of oxidative stress focusing on the low dose carcinogenicities of several genotoxic carcinogens such as a hepatocarcinogen contained in seared fish and meat, 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline, arsenic and its metabolites, and the kidney carcinogen potassium bromate.

Activation of the Nrf2 pathway by inorganic arsenic in human hepatocytes and the role of transcriptional repressor Bach1

Previous studies have proved that the environmental toxicant, inorganic arsenic, activates nuclear factor erythroid 2-related factor 2 (Nrf2) pathway in many different cell types. This study tried to explore the hepatic Nrf2 pathway upon arsenic treatment comprehensively, since liver is one of the major target organs of arsenical toxicity. Our results showed that inorganic arsenic significantly induced Nrf2 protein and mRNA expression in Chang human hepatocytes. We also observed a dose-dependent increase of antioxidant response element- (ARE-) luciferase activity. Both the mRNA and protein levels of NAD(P)H:quinone oxidoreductase 1 (NQO1) and heme oxygenase-1 (HO-1) were all upregulated dramatically. On the other hand, entry and accumulation of Nrf2 protein in the nucleus, while exportting the transcriptional repressor BTB and CNC homology 1 (Bach1) from nucleus to cytoplasm, were also confirmed by western blot and immunofluorescence assay. Our results therefore confirmed the arsenic-induced Nrf2 pathway activation in hepatocytes and also suggested that the translocation of Bach1 was associated with the regulation of Nrf2 pathway by arsenic. Hepatic Nrf2 pathway plays indispensable roles for cellular defenses against arsenic hepatotoxicity, and the interplay of Bach1 and Nrf2 may be helpful to understand the self-defensive responses and the diverse biological effects of arsenicals.

Risk of lung cancer associated with domestic use of coal in Xuanwei, China: retrospective cohort study

OBJECTIVE

To estimate the risk of lung cancer associated with the use of different types of coal for household cooking and heating.

SETTING

Xuanwei County, Yunnan Province, China.

DESIGN

Retrospective cohort study (follow-up 1976-96) comparing mortality from lung cancer between lifelong users of "smoky coal" (bituminous) and "smokeless coal" (anthracite).

PARTICIPANTS

27,310 individuals using smoky coal and 9962 individuals using smokeless coal during their entire life.

MAIN OUTCOME MEASURES

Primary outcomes were absolute and relative risk of death from lung cancer among users of different types of coal. Unadjusted survival analysis was used to estimate the absolute risk of lung cancer, while Cox regression models compared mortality hazards for lung cancer between smoky and smokeless coal users.

RESULTS

Lung cancer mortality was substantially higher among users of smoky coal than users of smokeless coal. The absolute risks of lung cancer death before 70 years of age for men and women using smoky coal were 18% and 20%, respectively, compared with less than 0.5% among smokeless coal users of both sexes. Lung cancer alone accounted for about 40% of all deaths before age 60 among individuals using smoky coal. Compared with smokeless coal, use of smoky coal was associated with an increased risk of lung cancer death (for men, hazard ratio 36 (95% confidence interval 20 to 65); for women, 99 (37 to 266)).

CONCLUSIONS

In Xuanwei, the domestic use of smoky coal is associated with a substantial increase in the absolute lifetime risk of developing lung cancer and is likely to represent one of the strongest effects of environmental pollution reported for cancer risk. Use of less carcinogenic types of coal could translate to a substantial reduction of lung cancer risk.

Induction of metallothionein I by arsenic via metal-activated transcription factor 1: critical role of C-terminal cysteine residues in arsenic sensing

Metal-activated transcription factor 1 (MTF1) mediates the induction of metallothioneins I and II by zinc and stress signals. The mechanism of MTF1 activation has not been well understood. We analyzed the interaction between arsenic (As(3+)) and MTF1 for Mt1 induction. As(3+) potently induces Mt1 mRNA expression in mouse hepa1c1c7 cells. Induction is dependent upon functional MTF1 as induction is lost in Mtf1 knockout cells but is restored upon reconstitution with Mtf1; moreover, As(3+) induces the binding of MTF1 to the metal response elements of endogenous Mt1. Induction is not affected by modulating zinc concentrations but is markedly enhanced by cycloheximide. Phenylarsine oxide (PAO), which covalently binds to vicinal protein cysteine thiol groups, induces Mt1 with a magnitude of higher potency than that of As(3+). PAO affinity beads effectively pulls down the carboxyl half of MTF1 (MTF1(321-675)) by binding to a cluster of five cysteine residues near the terminus. Preincubation with As(3+), Cd(2+), Co(2+), Ni(2+), Ag(+), Hg(2+), and Bi(3+) blocks pulldown of MTF1(321-675) by PAO beads in vitro and in vivo, indicating that binding of the metal inducers to the same C-terminal cysteine cluster as PAO occurs. Deletion of the C-terminal cysteine cluster or mutation of the cysteine residues abolishes or markedly reduces the transcription activation activity of MTF1 and the ability of MTF1 to restore Mt1 induction in Mtf1 knockout cells. The findings demonstrate a critical role of the C-terminal cysteine cluster of MTF1 in arsenic sensing and gene transcription via arsenic-cysteine thiol interaction.

Mitochondrial Damage Mediates Genotoxicity of Arsenic in Mammalian Cells

Arsenic is an important environmental carcinogen that affects millions of people worldwide through contaminated water supplies. For decades, arsenic was considered a nongenotoxic carcinogen. Using the highly sensitive A(L) mutation assay, we previously showed that arsenic is, indeed, a potent gene and chromosomal mutagen and that its effects are mediated through the induction of reactive oxygen species. However, the origin of these radicals and the pathways involved are not known. Here we show that mitochondrial damage plays a crucial role in arsenic mutagenicity. Treatment of enucleated cells with arsenic followed by rescue fusion with karyoplasts from controls resulted in significant mutant induction. In contrast, treatment of mitochondrial DNA-depleted (rho(0)) cells produced few or no mutations. Mitochondrial damage can lead to the release of superoxide anions, which then react with nitric oxide to produce the highly reactive peroxynitrites. The mutagenic damage was dampened by the nitric oxide synthase inhibitor, N(G)-methyl-L-arginine. These data illustrate that mitochondria are a primary target in arsenic-induced genotoxic response and that a better understanding of the mutagenic/carcinogenic mechanism of arsenic should provide a basis for better interventional approach in both treatment and prevention of arsenic-induced cancer.

Epidemiology of lung cancer

This review article presents lung cancer epidemiology, describing main epidemiologic characteristics including epidemiological situation in cancer incidence, mortality and survival in Europe in comparison with situation in the Czech Republic. Influence of environmental and life style risk factors like smoking, passive smoking, risk factors of work environment, ionizing radiation, air pollution, nutrition and genetic and hormonal factors are discussed.

Nested case-control study of lung cancer in four Chinese tin mines

OBJECTIVES

To evaluate the relation between occupational dust exposure and lung cancer in tin mines. This is an update of a previous study of miners with high exposure to dust at four tin mines in southern China.

METHODS

A nested case-control study of 130 male lung cancer cases and 627 controls was initiated from a cohort study of 7855 subjects employed at least 1 year between 1972 and 1974 in four tin mines in China. Three of the tin mines were in Dachang and one was in Limu. Cumulative total exposure to dust and cumulative exposure to arsenic were calculated for each person based on industrial hygiene records. Measurements of arsenic, polycyclic aromatic hydrocarbons (PAHs), and radon in the work sites were also evaluated. Odds ratios (ORs), standard statistic analysis and logistic regression were used for analyses.

RESULTS

Increased risk of lung cancer was related to cumulative exposure to dust, duration of exposure, cumulative exposure to arsenic, and tobacco smoking. The risk ratios for low, medium, and high cumulative exposure to dust were 2.1 (95% confidence interval (95% CI) 1.1 to 3.8), 1.7 (95% CI 0.9 to 3.1), and 2.8 (95% CI 1.6 to 5.0) respectively after adjustment for smoking. The risk for lung cancer among workers with short, medium, and long exposure to dust were 1.9 (95% CI 1.0 to 3.5), 2.3 (95% CI 1.3 to 4.1), and 2.3 (95% CI 1.2 to 4.2) respectively after adjusting for smoking. Several sets of risk factors for lung cancer were compared, and the best predictive model included tobacco smoking (OR=1.6, 95% CI 1.1 to 2.4) and cumulative exposure to arsenic (ORs for different groups from low to high exposure were 2.1 (95% CI 1.1 to 3.9); 2.1 (95% CI 1.1 to 3.9); 1.8 (95% CI 1.0 to 3.6); and 3.6 (95% CI 1.8 5 to 7.3)). No excess of lung cancer was found among silicotic subjects in the Limu tin mine although there was a high prevalence of silicosis. Exposures to radon were low in the four tin mines and no carcinogenic PAHs were detected.

CONCLUSIONS

These findings provide little support for the hypothesis that respirable crystalline silica induces lung cancer. Ore dust in work sites acts as a carrier, the exposure to arsenic and tobacco smoking play a more important part in carcinogenesis of lung cancer in tin miners. Silicosis seems not to be related to the increased risk of lung cancer.

Analysis of a historical cohort of Chinese tin miners with arsenic, radon, cigarette smoke, and pipe smoke exposures using the biologically based two-stage clonal expansion model

Hazelton, W. D., Luebeck, E. G., Heidenreich, W. F. and Moolgavkar, S. H. Analysis of a Historical Cohort of Chinese Tin Miners with Arsenic, Radon, Cigarette Smoke, and Pipe Smoke Exposures Using the Biologically Based Two-Stage Clonal Expansion Model. Radiat. Res. 156, 78-94 (2001).The two-stage clonal expansion model is used to analyze lung cancer mortality in a cohort of Yunnan tin miners based on individual histories with multiple exposures to arsenic, radon, cigarette smoke, and pipe smoke. Advances in methodology include the use of nested dose-response models for the parameters of the two-stage clonal expansion model, calculation of attributable risks for all exposure combinations, use of both a fixed lag and a gamma distribution to represent the time between generation of the first malignant cell and death from lung cancer, and scaling of biological parameters allowed by parameter identifiability. The cohort consists of 12,011 males working for the Yunnan Tin Corporation, with complete exposure records, who were initially surveyed in 1976 and followed through 1988. Tobacco and arsenic dominate the attributable risk for lung cancer. Of 842 lung cancer deaths, 21.4% are attributable to tobacco alone, 19.7% to a combination of tobacco and arsenic, 15.8% to arsenic alone, 11% to a combination of arsenic and radon, 9.2% to a combination of tobacco and radon, 8.7% to combination of arsenic, tobacco and radon, 5.5% to radon alone, and 8.7% to background. The models indicate that arsenic, radon and tobacco increase cell division, death and malignant conversion of initiated cells, but with significant differences in net cell proliferation rates in response to the different exposures. Smoking a bamboo water pipe or a Chinese long-stem pipe appears to confer less risk than cigarette use, given equivalent tobacco consumption.

Induction of oxyradicals by arsenic: implication for mechanism of genotoxicity

Although arsenic is a well-established human carcinogen, the mechanisms by which it induces cancer remain poorly understood. We previously showed arsenite to be a potent mutagen in human-hamster hybrid (A(L)) cells, and that it induces predominantly multilocus deletions. We show here by confocal scanning microscopy with the fluorescent probe 5',6'-chloromethyl-2',7'-dichlorodihydrofluorescein diacetate that arsenite induces, within 5 min after treatment, a dose-dependent increase of up to 3-fold in intracellular oxyradical production. Concurrent treatment of cells with arsenite and the radical scavenger DMSO reduced the fluorescent intensity to control levels. ESR spectroscopy with 4-hydroxy-2,2,6,6-tetramethyl-1-hydroxypiperidine (TEMPOL-H) as a probe in conjunction with superoxide dismutase and catalase to quench superoxide anions and hydrogen peroxide, respectively, indicates that arsenite increases the levels of superoxide-driven hydroxyl radicals in these cells. Furthermore, reducing the intracellular levels of nonprotein sulfhydryls (mainly glutathione) in A(L) cells with buthionine S-R-sulfoximine increases the mutagenic potential of arsenite by more than 5-fold. The data are consistent with our previous results with the radical scavenger DMSO, which reduced the mutagenicity of arsenic in these cells, and provide convincing evidence that reactive oxygen species, particularly hydroxyl radicals, play an important causal role in the genotoxicity of arsenical compounds in mammalian cells.

When to be skeptical of negative studies: pitfalls in evaluating occupational risks using population-based case-control studies

This study investigated arsenic and lung cancer incidence in a community setting in the Montreal area. Job histories and sociodemographic factors were collected by interview from 857 lung cancer cases, 533 general population controls, and 1,360 controls with other cancers. Chemist-hygienists assessed each subject's life-time occupational exposure to 294 substances. Logistic regressions yielded arsenic/lung cancer odds ratios of 1.1 (95% confidence interval = 0.60, 1.7) based on cancer controls, and 0.82 (95% confidence interval = 0.41, 1.6) based on population controls. Risk did not rise with increasing level or probability of exposure. Worksite studies consistently show lung carcinogenicity from arsenic. Since confounding from other chemicals was well controlled, the most likely explanation is substantially lower exposures than in previous studies. The lack of association in this study demonstrates the need for caution in interpreting negative findings from population-based case-control studies, particularly when exposures are low or rare, as well as the difficulty in generating hypotheses from such studies.

When to be skeptical of negative studies: pitfalls in evaluating occupational risks using population-based case-control studies

This study investigated arsenic and lung cancer incidence in a community setting in the Montreal area. Job histories and sociodemographic factors were collected by interview from 857 lung cancer cases, 533 general population controls, and 1,360 controls with other cancers. Chemist-hygienists assessed each subject's life-time occupational exposure to 294 substances. Logistic regressions yielded arsenic/lung cancer odds ratios of 1.1 (95% confidence interval = 0.60, 1.7) based on cancer controls, and 0.82 (95% confidence interval = 0.41, 1.6) based on population controls. Risk did not rise with increasing level or probability of exposure. Worksite studies consistently show lung carcinogenicity from arsenic. Since confounding from other chemicals was well controlled, the most likely explanation is substantially lower exposures than in previous studies. The lack of association in this study demonstrates the need for caution in interpreting negative findings from population-based case-control studies, particularly when exposures are low or rare, as well as the difficulty in generating hypotheses from such studies.

Mortality from lung cancer in Ontario uranium miners

Mortality from lung cancer was greater in Ontario uranium miners than in the general male population of Ontario (observed = 152, expected = 67.6, standardised mortality ratio 225, 95% confidence interval 191-264). Part of the excess of lung cancer may be because the proportion of men who are smokers or have smoked is greater in uranium miners than in Ontario men. Smoking does not explain the whole excess. Mortality from lung cancer in Ontario uranium miners is clearly related to exposure to short lived radon progeny. The excess relative risk of lung cancer from the same degree of exposure to short lived radon progeny is greatest five to 14 years after exposure and less subsequently. It is greater in men under the age of 55 years and less in older men. Part of the excess of lung cancer mortality in Ontario uranium miners is probably also due to exposure to arsenic that occurred earlier in gold mines. In Ontario uranium miners, the lung cancer mortality from exposure to arsenic increases as the intensity of exposure to short lived radon progeny increases. This finding is consistent with the hypothesis that the risk of lung cancer from exposure to arsenic is enhanced by exposure to other carcinogens. In Ontario uranium miners, the proportion of lung cancers that are small cell carcinomas is greater than in the general population. The proportion of small cell carcinomas is especially great five to 14 years after exposure to short lived radon progeny and in men who die from lung cancer at younger ages.

A nested case-control study of lung cancer among silica exposed workers in China

In an attempt to assess whether silica induces lung cancer, a nested case-control study of 316 male lung cancer cases and 1352 controls was carried out among pottery workers and tungsten, copper-iron, and tin miners from five provinces in south central China. Exposure to dust and silica for each study subject was evaluated quantitatively by cumulative exposure measures based on historical industrial hygiene records. Measurements on confounders such as inorganic arsenic, polycyclic aromatic hydrocarbons (PAHs), and radon were also collected from the worksites. Information on cigarette smoking was obtained by interviews of the subjects or their next of kin. A significant trend of increasing risk of lung cancer with exposure to silica was found for tin miners, but not for miners working in tungsten or copper-iron mines. Concomitant and highly correlated exposures to arsenic and PAHs among tin miners were also found. Risk of lung cancer among pottery workers was related to exposure to silica, although the dose-response gradient was not significant. Risks of lung cancer were significantly increased among silicotic subjects in iron-copper and tin mines, but not in pottery factories or tungsten mines. The results of this study provide only limited support for an aetiological association between silica and lung cancer.

Carcinoma of the lung in Ontario gold miners: possible aetiological factors

A cohort of 54,128 men who worked in Ontario mines was observed for mortality between 1955 and 1986. Most of these men worked in nickel, gold, or uranium mines; a few worked in silver, iron, lead/zinc, or other ore mines. If mortality that occurred after a man had started to mine uranium was excluded, an excess of carcinoma of the lung was found among the 13,603 Ontario gold miners in the study (standardised mortality ratio (SMR) 129, 95% confidence interval (95% CI) 115-145) and in men who began to mine nickel before 1936 (SMR 141, 95% CI 105-184). The excess mortality from lung cancer in the gold miners was confined to men who began gold mining before 1946. No increase in the mortality from carcinoma of the lung was evident in men who began mining gold after the end of 1945, in men who began mining nickel after 1936, or in men who mined ores other than gold, nickel, and uranium. In the gold mines each year of employment before the end of 1945 was associated with a 6.5% increase in mortality from lung cancer 20 or more years after the miner began working the mines (95% CI 1.6-11.4%); each year of employment before the end of 1945 in mines in which the host rock contained 0.1% arsenic was associated with a 3.1% increase in lung cancer 20 years or more after exposure began (95% CI 1.1-5.1%); and each working level month of exposure to radon decay products was associated with a 1.2% increase in mortality from lung cancer five or more years after exposure began (95% CI 0.02-2.4%). A comparison of two models shows that the excess of lung cancer mortality in Ontario gold miners is associated with exposure to high dust concentrations before 1946, with exposure to arsenic before 1946, and with exposure to radon decay products. No association between the increased incidence of carcinoma of the lung in Ontario gold miners and exposure to mineral fibre could be detected. It is concluded that the excess of carcinoma of the lung in Ontario gold miners is probably due to exposure to arsenic and radon decay products.

Epidemiological and experimental aspects of metal carcinogenesis: physicochemical properties, kinetics, and the active species

The carcinogenic properties of selected metals and their compounds are reviewed to provide a useful reference for existing knowledge on relationships between physical and chemical forms, kinetics and carcinogenic potential and between epidemiology, bioassays, and short-term tests. Extensive consideration is given to arsenic, beryllium, cadmium, chromium, lead, and nickel. Other metals such as antimony, cobalt, copper, iron, manganese, selenium, and zinc are discussed briefly.