Abstract
A mortality analysis has been carried out on a cohort of patients given Fowler's solution (potassium arsenite) for periods ranging from 2 weeks to 12 years between 1945 and 1969. An excess of fatal and non-fatal skin cancer was apparent, but there was no overall excess mortality from cancer. Further analyses by site of cancer, dose level, and time from first exposure are also presented. A subset of patients were examined in 1969-70 for the presence of arsenical keratoses, hyperpigmentation and skin cancer. About half the patients had one or more of these signs. Although the cancer mortality of this entire subgroup was similar to the expected value, all the cancer deaths occurred in patients with prior signs of arsenicism. These data suggest that while any excess of internal malignancy due to the use of Fowler's solution is small or non-existent, there may be a susceptible subgroup which can be identified from dermatological manifestations.
Highlights
Summary.-A mortality analysis has been carried out on a cohort of patients given Fowler's solution for periods ranging from 2 weeks to 12 years between 1945 and 1969
As the standardized mortality ratios (SMR) for all causes and all neoplasms for this part of Lancashire are 101 and 93 respectively, we have chosen not to adjust the expected values for them, though this suggests that the expected numbers we have used for cancers may be a few per cent too large
By the end of 1970, a subset consisting of 142 patients had been seen, and the presence of arsenical keratoses, hyperpigmentation, and skin cancer was recorded
Summary
From the * Imperial Cancer Research Fund, Cancer E_pidemiology and Clinical Trials Unit, University of Oxford, Gibson Laboratories, Radclife Infirmary, Oxford OX2 6HE. The cancer mortality of this entire subgroup was similar to the expected value, all the cancer deaths occurred in patients with prior signs of arsenicism. These data suggest that while any excess of internal malignancy due to the use of Fowler's solution is small or non-existent, there may be a susceptible subgroup which can be identified from dermatological manifestations. In that report, as in some others (Sommers & McManus, 1953; Mabuchi et al, 1980), a relationship between the signs of arsenic toxicity (keratoses and hyperpigmentation) and internal malignancies has been suggested, but none of these studies have had a reference set of expected values from which comparisons andl inferences could be drawn. The two case-control studies (Dobson et al, 1965; Bean et al, 1.968) which investigated the presence of keratoses at the time of diagnosis of cancer have reportedl contradictory ftL(lings
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