Arsenic Exposure and Upper Tract Urothelial Carcinoma Outcomes — Expert Commentary

Arsenic exposure is associated with a higher risk of developing urothelial carcinoma (UC). Previous studies mostly focused on UC of the bladder. A deeper understanding of how this environmental exposure affects clinical outcomes in upper tract urothelial carcinoma (UTUC) is needed.


A recent study by López et al. in Urologic Oncology: Seminars and Original Investigations examined UTUC clinical outcomes in an arsenic-exposed region in Northern Chile (Antofagasta) and compared them to the rest of the country. The authors point out that in this region, the mean arsenic concentrations rose to 870 mg/l, exposing the whole population to arsenic levels up to 17 times the WHO recommended levels for several decades. While the exposure ended several years ago, its long-term effects persist. The authors identified 257 UTUC-specific deaths in Chile between 1990 and 2016.  The mortality rate was 2.15/100,000 in the arsenic exposed region compared to 0.07/100,000 in the rest of the country (mortality rate ratio 17.6; 95%CI: 13.5−22.9). The mean age at the time of UTUC cancer-specific death was significantly lower in the exposed region (63.3 vs. 69.0 years; P < 0.001). UTUC-related hospital discharges were also significantly higher (RR 14.8; 95%CI: 11.5−19.1).

The study has limitations but describes a significant epidemiological association between arsenic exposure and worse clinical outcomes UTUC patients. A deeper understanding of the mechanisms mediating these effects is critical. This is particularly important to prevent or mitigate the long-term impact of environmental exposures, which may persist for several years after the exposure itself stops.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

References: 
  1. López JF, Fernández MI, Coz LF. “Arsenic exposure is associated with significant upper tract urothelial carcinoma health care needs and elevated mortality rates.” Urol Oncol. 2020 Feb 19. pii: S1078-1439(20)30034-X. doi: 10.1016/j.urolonc.2020.01.014. PMID: 32088105
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