Arsenic cancer risk confounder in Southwest Taiwan data set

Steven H. Lamm, Arnold Engel, Cecilia A. Penn, Rusan Chen, Manning Feinleib

Research output: Contribution to journalArticlepeer-review

74 Scopus citations


Quantitative analysis for the risk of human cancer from the ingestion of inorganic arsenic has been based on the reported cancer mortality experience in the blackfoot disease (BFD)-endemic area of southwest Taiwan. Linear regression analysis shows that arsenic as the sole etiologic factor accounts for only 21% of the variance in the village standardized mortality ratios for bladder and lung cancer. A previous study had reported the influence of confounders (township, BFD prevalence, and artesian well dependency) qualitatively, but they have not been introduced into a quantitative assessment. In this six-township study, only three townships (2, 4, and 6) showed a significant positive dose-response relationship with arsenic exposure. The other three townships (0, 3, and 5) demonstrated significant bladder and lung cancer risks that were independent of arsenic exposure. The data for bladder and lung cancer mortality for townships 2, 4, and 6 fit an inverse linear regression model (p <0.001) with an estimated threshold at 151 μg/L (95% confidence interval, 42 to 229 μg/L). Such a model is consistent with epidemiologic and toxicologic literature for bladder cancer. Exploration of the southwest Taiwan cancer mortality data set has clarified the dose-response relationship with arsenic exposure by separating out township as a confounding factor.

Original languageEnglish (US)
Pages (from-to)1077-1082
Number of pages6
JournalEnvironmental Health Perspectives
Issue number7
StatePublished - Jul 2006


  • Arsenic
  • Blackfoot disease
  • Bladder cancer
  • Cancer risk
  • Confounder
  • Dose-response relationship
  • Southwest Taiwan
  • Threshold model

ASJC Scopus subject areas

  • Environmental Science(all)
  • Environmental Chemistry
  • Public Health, Environmental and Occupational Health


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