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Cell Type Specificity of Lung Cancer Associated with Arsenic Ingestion

Departments of ¹ Environmental and Occupational Health and ² Pathology, National Cheng Kung University Medical College, Tainan, Taiwan; ³ Chungtai Institute of Health Sciences and Technology, Pei-tun District, Taichung, Taiwan; ⁴ Department of Environmental Health, Harvard School of Public Health, Boston, MA; and ⁵ Channing Laboratory, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, MA

Requests for reprints: How-Ran Guo, Department of Environmental and Occupational Health, Medical College, National Cheng Kung University, 138 Sheng-Li Road, Tainan 70428, Taiwan. Phone: 886-6-235-3535 ext. 5802; Fax: 886-6-275-2484. E-mail: hrguo{at}mail.ncku.edu.tw

Arsenic is a well-documented human carcinogen. Previous studies on urinary bladder and skin cancers have shown that arsenic can cause specific cell types of malignancy. To evaluate whether this is also true for lung cancers, we conducted a study on 243 townships in Taiwan. We identified patients through the National Cancer Registry Program and compared the proportion of each major cell type between an endemic area of arsenic intoxication with exposures through drinking water, which includes 5 of the townships and the other 238 townships. To control for gender and age, we analyzed data on men and women separately and divided patients into four age groups. A total of 37,290 lung cancer patients, including 26,850 men and 10,440 women, was diagnosed between January 1, 1980 and December 31, 1999 in study townships. Patients from the endemic area had higher proportions of squamous cell and small cell carcinomas, but a lower proportion of adenocarcinomas. These findings were similar across all age groups in both genders, although the lack of data on smoking is a limitation of our study. The results suggested that the carcinogenicity of arsenic on lungs is also cell type-specific: squamous cell and small cell carcinomas appeared to be related to arsenic ingestion, but not adenocarcinoma. Whereas data in the literature are limited, the association between adenocarcinoma and arsenic exposures through inhalation appeared to be stronger than that of squamous cell carcinoma. Therefore, we speculate that arsenic may give rise to different mechanisms in the development of lung cancers through different exposure routes.

Key Words: arsenic • lung cancer • cell type specificity • drinking water • environmental health