Histopathology of Cervical Cancer and Arsenic Concentration in Well Water: An Ecological Analysis.

Mohammad Golam Mostafa,Nicola Cherry,Zarat Jahin Queen

doi:10.3390/ijerph14101185

Abstract

Arsenic in drinking water is causally linked with cancer of the skin, lung, and urinary bladder, but there is very little data on a possible role for arsenic in the etiology of cervical cancer, a disease in which human papilloma virus is held to be a necessary but not sufficient cause. All histopathology results from cervical specimens from the National Institute of Cancer Research and Hospital (NICRH), Dhaka (1997–2015), and the Anowara Medical Services (2003–2015), both serving the whole of Bangladesh, were classified by cell type. Arsenic concentrations in well water in the thana of residence were estimated from systematic sampling carried out by the British Geological Survey. In a case-referent analysis arsenic estimates for cases of cervical cancer were compared with those found to have benign lesions. In this study, 3464 NICRH (CH) cervical specimens and 30,050 community medical service (CMS) specimens were available: 3329 (CH) and 899 (CMS) were recorded as malignant. Most were squamous cell carcinoma, of which 4.9% were poorly differentiated. Overall, there was no increase in cervical cancer with increasing arsenic concentration. Among those with squamous cell histology, a strong dose response was seen for poorly differentiated cancer with increasing arsenic exposure. The odds ratio increased monotonically, compared with exposure <10 μg/L, from 1.58 at 10 < 50 μg/L to 8.11 at >200 μg/L (p < 0.001). Given the high proportion of Bangladeshis using drinking water containing >50 μg/L of arsenic, the evidence that arsenic is implicated in cancer grade suggests a need for further investigation and the introduction of cervical screening in high arsenic areas.

Highlights

Given the high proportion of Bangladeshis using drinking water containing >50 μg/L of arsenic, the evidence that arsenic is implicated in cancer grade suggests a need for further investigation and the introduction of cervical screening in high arsenic areas
It is well established that arsenic in drinking water is a causal factor in cancers of the urinary bladder, lung, and skin [1], and that data for renal cancer is suggestive of causality [2], there has been almost no investigation of a possible link between arsenic exposure and cancer of the uterine cervix, the second most frequent female cancer in most Asian countries [3,4]
The National Institute of Cancer Research and Hospital (NICRH) (CH) series included data for all cases from 1997 to 2015 in which cervical specimens had been examined for patients seen at or admitted to the NICRH in Dhaka, Bangladesh

Summary

Introduction

It is well established that arsenic in drinking water is a causal factor in cancers of the urinary bladder, lung, and skin [1], and that data for renal cancer is suggestive of causality [2], there has been almost no investigation of a possible link between arsenic exposure and cancer of the uterine cervix (cervical cancer), the second most frequent female cancer in most Asian countries [3,4]. Included six deaths from cervical cancer in their study of arsenic related mortality in 42 villages in Taiwan. The number was too small to reach any conclusion, they reported an increase in standardized mortality ratio with higher arsenic exposures. One study from India investigated the relation between arsenic exposure and oxidative stress (as reflected in malondialderhyde (MDA)). In cervical cancer cases and referents and reported higher levels of arsenic and MDA in cases [6]. In Bangladesh, a high proportion of the population is exposed to arsenic in drinking water, with 27%. Republic of Bangladesh, found to have arsenic concentration >50 μg/L [7].

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