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Arsenic in Drinking Water and Bladder Cancer Mortality in the United States: An Analysis Based on 133 U.S. Counties and 30 Years of Observation

Lamm, Steven H. MD; Engel, Arnold MD; Kruse, Michael B. PhD; Feinleib, Manning MD; Byrd, Daniel M. PhD; Lai, Shenghan PhD; Wilson, Richard DPhil

Journal of Occupational and Environmental Medicine: March 2004 - Volume 46 - Issue 3 - p 298-306
doi: 10.1097/01.jom.0000116801.67556.8f

This study analyzes the relationship between arsenic exposure through drinking water and bladder cancer mortality. The county-specific white male bladder cancer mortality data (1950–1979) and county-specific groundwater arsenic concentration data were obtained for 133 U.S. counties known to be exclusively dependent on groundwater for their public drinking water supply. No arsenic-related increase in bladder cancer mortality was found over the exposure range of 3 to 60 μg/L using stratified analysis and regression analyses (both unweighted and weighted by county population and using both mean and median arsenic concentrations). These results, which provide a direct estimate of arsenic-related cancer risk for U.S. residents, exclude the National Research Council’s 2001 risk estimate that was based on Southwest Taiwan data and required adjusting for differences between the body mass and water consumption rates of U.S. and Taiwanese residents.

From Consultants in Epidemiology and Occupational Health, Inc., Washington, DC.

Address correspondence to: Steven H. Lamm, MD, Consultants in Epidemiology and Occupational Health, Inc. (CEOH), 2428 Wisconsin Avenue, NW, Washington, DC 20007; E-mail address:

An earlier draft of this paper was submitted to the Environmental Protection Agency October 31, 2001. Earlier drafts of this paper were also presented at the 5th International Conference on Arsenic Exposure and Health Effects in San Diego, CA, July 2002 and at the United States Geological Survey’s “Natural Science and Public Health” Conference in Reston, VA, April 1–3, 2003.

©2004The American College of Occupational and Environmental Medicine