Abstract
Prior investigations identified an association between low-level blood arsenic (As) and bladder cancer risk among Tunisian men but questions remain regarding confounding by cadmium (Cd), a well-established bladder carcinogen. A case–control study of Tunisian men was re-examined to assess the levels of cadmium in blood and reparse the association between the simultaneous exposure to these metals and bladder cancer risk. Levels of blood Cd were significantly twice higher among cases than in controls (P < 0.05) and were positively correlated with smoking and age. Additionally, analysis of metal levels among non-smokers according to the region of residence showed very high blood Cd and As levels for the coastal regions of Sfax and central Tunisia. After controlling for potential confounders, for low blood As levels (<0.67 μg/L), the OR for blood Cd was 4.10 (95 % CI 1.64–10.81), while for higher levels (>0.67 μg/L), it was reduced to 2.10 (CI, 1.06–4.17). Adjustment for Cd exposure did not alter the risk associated to As exposure. This study is the first to report the relationship between Cd exposure and risk of bladder cancer occurrence in interaction with smoking and As exposure. Smoking is shown to be the main exposure source to Cd in the Tunisian population but also environmental pollution seems to be responsible of Cd exposure among non-smokers. Exposure assessment studies encompassing a wider population are needed.
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Acknowledgments
Authors express their sincere thanks to the medical staff in Sfax Hospital who facilitated sampling procedures and data collection on the subjects of the study. Acknowledgements are also addressed to the technical team in the Department of Toxicology and Legal Medicine, Faculty of Medicine of Granada for their considerable assistance in the analysis of metals.
Disclosure statement
The study received ethics approval. Funding was provided by the Ministry of High Education and Scientific research in Tunisia. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors have no competing financial interests to report.
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Feki-Tounsi, M., Olmedo, P., Gil, F. et al. Cadmium in blood of Tunisian men and risk of bladder cancer: interactions with arsenic exposure and smoking. Environ Sci Pollut Res 20, 7204–7213 (2013). https://doi.org/10.1007/s11356-013-1716-8
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DOI: https://doi.org/10.1007/s11356-013-1716-8