Page 101 - JCTR-11-3

Journal of Clinical and
Translational Research Household arsenic and bladder cancer

A B

Figure 6. Drinking water arsenic concentrations across 50 patients with urothelial cell carcinoma or benign urologic diseases, categorized by (A) area
deprivation index (ADI; p=0.11) and (B) the United States Department of Agriculture Rural-Urban Continuum Codes (RUCC; 1 = Most urban; p=0.046
between groups)

urinary 3-HPMA levels between UCC and control patients. with a larger sample size are warranted, ideally with the
While their concentrations were comparable to the medians assessment of urinary chemical exposures at multiple
observed in our population (193 – 195 ng/mg creat), the time points. It would also be beneficial to collect more
authors paradoxically found lower urinary 3-HPMA/creat detailed information on potentially confounding UCC
42
concentrations in UCC cases versus controls. However, the risk factors, such as diet or total trihalomethane exposure
analyzed UCC patients had chronic kidney disease, which from municipal water, and to include additional urinary
47
could have affected urinary 3-HPMA excretion. chemical exposures, such as aromatic amines. 48
We did not observe differences in urinary 3-HPMA In addition, while none of the patients had genotoxic
between patients living in urban versus rural areas. urinary concentrations of iAs, our genotoxic threshold
Although acrolein is generated from vehicular exhaust, it was based on DNA strand breaks. Arsenic exposure
18
is also a component of indoor air pollution, especially in thresholds for oxidative stress and inhibition of DNA
smoking households. Although all patients in our study repair still need to be established in human urothelial cells.
43
were self-reported current non-smokers, urinary cotinine Overall, we found that patients with UCC had higher
was detected in 5 of 50 subjects. Therefore, we cannot rule concentrations of arsenic in indoor household dust, which
out tobacco smoke or electronic cigarettes as sources significantly correlated with urinary iAs concentrations
44
of urinary 3-HPMA in some participants. Other major across all subjects. Although drinking water arsenic levels
sources of acrolein in non-smoking households include
heated cooking oils and wood-burning fireplaces. 45 were higher in households located in more rural areas
and with higher area deprivation scores, these were not
Patients with UCC in our study were less likely to associated with urinary arsenic concentrations or UCC in
have completed any post-college education compared our study population. Our data suggest that indoor dust
to controls from the same urology clinic. This finding is arsenic, rather than arsenic in drinking water, was a likely
consistent with larger studies reporting lower educational source of urinary arsenic exposures in this primarily non-
attainment among UCC patients compared to unaffected smoking population. Simple home arsenic remediation
controls, 10,46 even when adjusted for smoking. The strategies, such as using HEPA vacuum cleaners and
9
reasons for higher UCC risk among individuals with HEPA air filtration units, should be considered for patients
lower educational attainment are not fully understood. diagnosed with UCC. 36,37
Our study has several limitations, including a small
sample size and the collection of samples at a single time 5. Conclusion
point. Some patients had lived in their current homes for Arsenic in household dust is associated with urinary iAs
a short duration, and we did not have access to household concentrations and may contribute to UCC risk in non-
samples from previous residences. Follow-up studies smokers. The impact of household arsenic remediation

Volume 11 Issue 3 (2025) 95 doi: 10.36922/jctr.24.00065