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Catterina ferreccio nuevas evidencias sobre los efectos crónicos de la exposición a arsénico en agua potable en chile

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  • 1. Nuevas evidencias sobre los efectos crónicos de la exposición a arsénico en agua potable en Chile. Catterina Ferreccio Readi Departamento de Salud Pública www.saludpublicauc.cl Pontificia Universidad Católica de Chile Santiago 2013
  • 2. Regiones del Norte de Chile Lugar más seco del mundo Pocas fuentes de agua Todos toman agua de la misma fuente Hay registros históricos de los niveles de As en todas las fuentes de agua +
  • 3. Arsénico en agua potable 1950-04 (µg/L) Años Antof. Tocopilla Calama 1930-57 90 250 150 1958-70 860 250 150 1971-77 110 636 287 1978-79 110 110 110 1980-87 70 110 110 1988-94 40 40 40 1995-03 40 40 40 2004-05 10 10 10
  • 4. Prom ajustado de As ( g/L) agua Reg II, 50-94
  • 5. Short term effects: Neonatal mortality rates for Antofagasta and Valparaiso, 1950 to 1996. Chronic Arsenic Exposure and Risk of Infant Mortality in Two Areas of Chile. Environmental Health Perspectives 2000. 108 (1) 7
  • 6. Late fetal mortality rates for Antofagasta and Valparaiso, 1950 to 1996. Environmental Health Perspectives
  • 7. 0.5 1 1.5 2 1950 1960 1970 1980 1990 2000 Year RateRatios Male Female Acute Myocardial Infarction Mortality Region II of Chile from 1950 to 2000 High As Exposure Period Yuan Y. et al. Am J Epidemiol. 2007.
  • 8. Exposición niñez Expuesto sólo como adultos
  • 9. Mortalidad (SMRs) EPOC, edad 30-49 años, expuestos in-utero o expuestos en la niñez Smith AH, Marshall G, Yuan Y, Ferreccio C, Liaw J, von Ehrenstein OS, Steinmaus1, Bates MN, and Selvin S. Environ Health Perspect 114:1293-96, 2006.
  • 10. Evidence From Chile That Arsenic in Drinking Water May Increase Mortality From Pulmonary Tuberculosis American Journal of Epidemiology
  • 11. Mortality in young adults following in utero and early childhood exposure to arsenic in drinking water
  • 12. RIESGO DE CANCER PULMONAR INTERACCION ARSENICO/TABACO. Casos y Controles. 1994-1996
  • 13. Smoking category Arsenic (µg/L)a Bladder cancer Lung cancer OR OR Never-smoker <11 1.00 1.00 11-91 2.66 0.68 92-335 7.01 0.93 >335 8.86 2.04 Heavier smoker <11 4.12 3.75 11-91 4.72 4.39 92-335 7.08 12.4 >335 23.21 16.26 OR for Bladder and Lung Cancer and Arsenic in Water, by Smoking Status, Northern Chile, 2007-2010
  • 14. Cancer OR; only cases histologically confirmed, non- proxy, sex. Upper/lower quart avge lifetime As concentr prior to 1971 OR adjusted for age, sex, smoking, mining work, race, body-mass index, and SES. bladder ca OR in females of 23.6 (4.14-135.3) is truncated.
  • 15. Lung Ca OR in Men by As an other exposures, 2007-2010 (Epidem 2013) Other agent: Exposed Unexposed Exposed Synergy index Arsenic:a Low exposure High exposure High exposure OR (95% CI) OR (95% CI) OR (95% CI) S (95% CI) Any carcinogen 1.8 (0.6- 5.4) 5.2 (1.8-15.3) 12.1 (3.8-38.4) 2.2 (0.9-5.5) Asbestos 1.6 (0.1-17.8) 6.0 (2.8-12.3) 16.2 (2.8-95.1) 2.7 (0.5-14.4) Silica 1.8 (0.6- 5.6) 6.2 (2.6-14.8) 13.0 (3.9-42.8) 2.0 (0.8-5.2) Wood dust 2.5 (0.8- 7.7) 7.6 (3.2-17.9) 26.5 (6.0-116.8) 3.1 (1.1-9.3) Welding fumes 1.0 (0.3- 3.2) 5.6 (2.4-12.8) 11.9 (3.7-38.1) 2.4 (0.8-7.1) Coke oven 0.9 (0.2- 3.6) 6.0 (2.7-13.0) 6.5 (2.2-19.2) 1.1 (0.4-3.1) Soot 1.7 (0.4- 6.5) 6.3 (2.9-13.5) 16.1 (2.2-117.0) 2.5 (0.6-11.3) Fiberglass 1.4 (0.2- 7.4) 6.1 (2.9-12.8) 14.4 (2.6-80.6) 2.5 (0.6-10.9)
  • 16. Kidney Cancer OR by As Intake and Histologic Subtype, Chile, 2007-10 Type of cancer Renal pelvis & ureter Renal cell Exposure As intake Contr Case OR 95% CI No. Cases OR 95% CI Lifetime average (µg/day) <48 219 1 1.00 26 1.00 48-167 211 3 4.68 0.3, 67.3 32 1.29 0.7. 2.3 >167 210 14 19.3 2.4, 154.4 23 1.01 0.5, 1.9 p-trend=0.0006 p-trend=0.98 Cum. expos (mg) Before 1971 <0.7 218 1 1.00 27 1.00 0.7-6.1 213 3 4.83 0.4, 60.6 28 1.27 0.7, 2.3 >6.1 205 14 19.0 2.4-152.7 24 1.24 0.7, 2.3 p-trend=0.0003 p-trend=0.5
  • 17. Early-life As and lung function residuals (observed minus predicted) and %of age-, sex-, and height- predicted values (mean ± SD) Peak arsenic before age 10 <50 μg/l (n = 45) 50–250 μg/l (n = 20) >800 μg/l (n = 32) Percent predicted FEV1 98.2 ± 14.6 91.2 ± 11.0 88.1 ± 18.3 Percent predicted FVC 103.6 ± 16.7 98.2 ± 10.0 94.7 ± 15.3 FEV1 residual (ml) −63 ± 443 −270 ± 314 −375 ± 611 FVC residual (ml) 103 ± 584 −54 ± 380 −226 ± 614
  • 18. Temas de investigación en desarrollo • Duración del riesgo luego de detenida la exposición • Riesgo de otros cánceres como mama y próstata • Identificar bio-marcadores de riesgo para detección precoz
  • 19. Protección a la población expuesta Prevención primaria: 1. As: mantener en el agua <10 ug/L (Norma Regional menor?) 2. Reducir exposición al tabaco 3. Promover: frutas-verduras, actividad física. Prevención Secundaria 1. Alertar al cuerpo médico 2. Tamizaje?
  • 20. References • Ferreccio C, C. Arsenic, tobacco smoke, and occupation: associations of multiple agents with lung and bladder cancer. Epidemiology. 2013 Nov;24(6):898-905. • Ferreccio C, Case-control study of arsenic in drinking water and kidney cancer in uniquely exposed northern chile. Am J Epidemiol. 2013 Sep 1;178(5):813-8. • Steinmaus CM, Drinking water arsenic in northern chile: high cancer risks 40 years after exposure cessation. Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):623-30. d • Smith AH,. Mortality in young adults following in utero and childhood exposure to arsenic in drinking water. Environ Health Perspect. 2012 Nov;120(11):1527-31. • Smith AH, Evidence from Chile that arsenic in drinking water may increase mortality from pulmonary tuberculosis. Am J Epidemiol. 2011 Feb 15;173(4):414-20. • Dauphiné DC Lung function in adults following in utero and childhood exposure to arsenic in drinking water: preliminary findings. Int Arch Occup Environ Health. 2011 Aug;84(6):591-600. • Yuan Y, Marshall G, Ferreccio C, Steinmaus C, Liaw J, Bates M, Smith AH. Kidney cancer mortality: fifty-year latency patterns related to arsenic exposure. Epidemiology. 2010 Jan;21(1):103-8. • Liaw J, Increased childhood liver cancer mortality and arsenic in drinking water in northern Chile. Cancer Epidemiol Biomarkers Prev. 2008 Aug;17(8):1982-7. • Yuan Y, Acute myocardial infarction mortality in comparison with lung and bladder cancer mortality in arsenic-exposed region II of Chile from 1950 to 2000. Am J Epidemiol. 2007 Dec 15;166(12):1381-91. • Marshall G, Fifty-year study of lung and bladder cancer mortality in Chile related to arsenic in drinking water. J Natl Cancer Inst. 2007 Jun 20;99(12):920-8.
  • 21. • Smith AH, Increased mortality from lung cancer and bronchiectasis in young adults after exposure to arsenic in utero and in early childhood. Environ Health Perspect. 2006 Aug;114(8):1293-6. • Ferreccio C. [Bronchopulmonary cancer in workers exposed to arsenic: a case control study]. Rev Med Chil. 1996 Jan;124(1):119-23. • Ferreccio C, Arsenic exposure and its impact on health in Chile. J Health Popul Nutr. 2006 Jun;24(2):164-75. Review. • Hopenhayn C, Profile of urinary arsenic metabolites during pregnancy. Environ Health Perspect. 2003 Dec;111(16):1888-91. • Moore LE,. P53 alterations in bladder tumors from arsenic and tobacco exposed patients. Carcinogenesis. 2003 Nov;24(11):1785-91. • Moore LE,. Arsenic-related chromosomal alterations in bladder cancer. J Natl Cancer Inst. 2002 Nov 20;94(22): • Ferreccio C, Lung cancer and arsenic concentrations in drinking water in Chile. Epidemiology. 2000 Nov;11(6):673-9. • Hopenhayn-Rich C,. Chronic arsenic exposure and risk of infant mortality in two areas of Chile. Environ Health Perspect. 2000 Jul;108(7):667-73. • Biggs ML, Arsenic-laced water in Chile. Science. 1998 Aug 7;281(5378):785. PubMed PMID: 9714681.