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Elevated bladder cancer in northern New England: The role of drinking water and arsenic

January 1, 2016

Background: Bladder cancer mortality rates have been elevated in northern New England for at least five decades. Incidence rates in Maine, New Hampshire, and Vermont are about 20% higher than the United States overall. We explored reasons for this excess, focusing on arsenic in drinking water from private wells, which are particularly prevalent in the region.

Methods: In a population-based case-control study in these three states, 1213 bladder cancer case patients and 1418 control subjects provided information on suspected risk factors. Log transformed arsenic concentrations were estimated by linear regression based on measurements in water samples from current and past homes. All statistical tests were two-sided.

Results: Bladder cancer risk increased with increasing water intake ( Ptrend = .003). This trend was statistically significant among participants with a history of private well use ( Ptrend = .01). Among private well users, this trend was apparent if well water was derived exclusively from shallow dug wells (which are vulnerable to contamination from manmade sources, Ptrend = .002) but not if well water was supplied only by deeper drilled wells ( Ptrend = .48). If dug wells were used pre-1960, when arsenical pesticides were widely used in the region, heavier water consumers (>2.2 L/day) had double the risk of light users (<1.1 L/day, Ptrend = .01). Among all participants, cumulative arsenic exposure from all water sources, lagged 40 years, yielded a positive risk gradient ( Ptrend = .004); among the highest-exposed participants (97.5th percentile), risk was twice that of the lowest-exposure quartile (odds ratio = 2.24, 95% confidence interval = 1.29 to 3.89).

Conclusions: Our findings support an association between low-to-moderate levels of arsenic in drinking water and bladder cancer risk in New England. In addition, historical consumption of water from private wells, particularly dug wells in an era when arsenical pesticides were widely used, was associated with increased bladder cancer risk and may have contributed to the New England excess.

Publication Year 2016
Title Elevated bladder cancer in northern New England: The role of drinking water and arsenic
DOI 10.1093/jnci/djw099
Authors Dalsu Baris, Richard Wadell, Laura Freeman, Molly Schwenn, Joanne Colt, Joseph D. Ayotte, Mary Ward, John Nuckols, Alan Schned, Brian Jackson, Castine Clerkin, Nathanial Rothman, Lee Moore, Anne Taylor, Gilpin Robinson, Monawar G. Hosain, Carla Armenti, Richard McCoy, Claudine Samanic, Robert Hoover, Joseph Fraumeni, Alison Johnson, Margaret Karagas, Debra Silverman
Publication Type Article
Publication Subtype Journal Article
Series Title Journal of the National Cancer Institute
Index ID 70182755
Record Source USGS Publications Warehouse
USGS Organization Eastern Mineral and Environmental Resources Science Center; NH/VT office of New England Water Science Center