Cancer
Introduction
Cancer is rated as the second principal cause of death worldwide (Baris, Waddell, Beane Freeman, Schwenn, Colt Ayotte, Clerkin, 2016). In 2018, an estimated 9.6 million deaths were as a result of cancer (Baris et al 2016). The understandings that cancer is the leading and increasingly a health issue is facilitating attempts to assist national governments to take steps in tackling the issue. Generally speaking, addressing the increasing cancer prevalence and the death rates is problematic at various stages. However, increasing involvement has been effective in the United States in fighting against cancer. The national cancer institute center of global health serves a crucial role in cancer health attempts. This body aims to establish long-lasting global partnerships to promote strategies that tackle international gaps in the dissemination of information and excellent practices. Although cancer does not have a single cause, an interaction between several factors including high levels of arsenic in drinking water generates cancer.
Arsenic is a naturally occurring substance that exists in high amounts in groundwater of many countries (Koutros, Baris, Waddell, Beane Freeman, Colt, Schwenn, Stolzenberg 2018). The substance is very toxic and hence its long-term exposure can lead to cancer. Therefore, to prevent cancer cases arising from arsenic, communities must access and afford a safe water supply. In most cases, a high inorganic arsenic level is found in drinking contaminated water. Arsenic in drinking water is a global public health issue upsetting millions of people (Koutros et al 2018). Elevated contact levels to arsenic in drinking water have been linked to increasing cases of cancer. This connection is mainly based on the inspection of extremely exposed populations. People who relied heavily on
shallow dug wells in areas associated with arsenic-based pesticide application. According to Koutros et al (2018) contact with inorganic in drinking water associates a cancer risk for humans with a tough emphasis on bladder cancer. Currently, several specific and several tests are used to measure the level of arsenic in the body. However, measuring arsenic in urine is the most accessible yet less effective test to detect arsenic exposures within some days. The purpose of the current study is to inspect the associations between arsenic in drinking water and bladder cancer.
Methodology
This study extracted 50 patients newly diagnosed with bladder cancer. The study, however, exempted patients who had a history of bladder cancer. Data was collected from the urologic oncology database at the University of California (Saint-Jacques, Brown, Nauta, Boxall, Parker, Dummer, 2018). The bladder cancer diagnosis was approved in all patients. This database is preserved by the San Francisco Department of Oncology. Every patient in the study had 94 columns of demographic and medical information such as sex, age, cancer differentiation treatment and results. Also, this study classified cancer grade and stage according to world health guidelines. The obtained information consisted of mortalities and the date of mortalities through 2015. The interval between the dates of bladder cancer diagnosis and mortality represented the median duration of follow-up. Moreover, this study applied the Kaplan-Meier statistical method to analyze survival results. Possibility tables were generated to enable comparison. This study chose California due to high deaths resulting from bladder cancer in the county. Besides, this region once recorded high relative risks of arsenic with a wide range existing in drinking water. Urologists and pathologists categorized bladder cancer patients. Levels of exposure to arsenic for each individual were classified through measurements of arsenic concentrations in the water.
Bladder cancer develops when the bladder cells generate mutational alterations in their DNA (Boffetta, Borron, 2019). More often, bladder cancer develops within the cells on the inner lining of the bladder. Three common types of bladder cancer depend on the nature of the tumour cells under the microscope. Urothelial is the most common among the three types and accounts for about 90% of all bladder cancers (Koutros et al 2018). Besides, urothelial is responsible for about 10%-15% of kidney cancers among adults. This type of cancer develops in the urothelial cells within the urinary tract. Also, blood cancer is often described as non-invasive, non-muscle-invasive, and muscle-invasive. Noninvasive is a bladder cancer that has not spread into the bladder muscle but instead is maintained in the bladder lining (Koutros et al 2018). This is the early stage of bladder cancer and is often treatable whereby cancer cells can be removed while maintaining the rest of the bladder undamaged. On the other hand, non-muscle-invasive typically grows into the lamina propria. However, on an important note, this type of cancer can spread to other body parts.
Characteristics of bladder cancer
Bladder cancer detection during the early stages is often possible due to the presence of blood in the urine (Koutros et al 2018). Also, symptoms are usually so uncomfortable that a person would have to consult a doctor. Arguably, the greatest impact of bladder cancer on other body processes differs depending on the treatment available. For example, harm to nerves within the pelvic part may interfere with erections. Moreover, radiation therapy can affect bowel movements including the presence of diarrhea.
Sources of exposure to arsenic
Generally speaking, people are exposed to higher arsenic levels through various ways including utilization of infected water to prepare food, irrigation of food crops, industrial processes, eating impure food and smoking tobacco (Mendez, Eftim, Cohen, Warren, Cowden, Lee, Sams, 2017). In industries, for example, arsenic is used as an alloying agent and also in the processing of various products. Besides, it is used in the hide tanning process. Since arsenic is naturally present in the ground, tobacco can take up the natural inorganic arsenic from the soil. Also, possible exposure to higher levels of arsenic is greater when arsenate insecticide is used to tobacco.
The magnitude of the problem
Individuals, population groups and geographical areas experience different signs and symptoms of long-term and high levels of exposure to inorganic arsenic (Baris et al 2016). Moreover, there no single approach used to differentiate between bladder caused by arsenic and other risk factors. Due to this, there is a consistent approximation of the magnitude of the arsenic problem globally.
Prevention and control of arsenic poisoning
The most crucial action to protect the affected communities is to prevent additional exposure to arsenic by supplying safe drinking water, providing secure water for food preparation and irrigation of crops (Koutros et al 2018). Besides, there are various alternatives to decrease levels of arsenic in drinking water. For example, the substitution of high arsenic sources with low arsenic and microbiology sources could reduce arsenic levels in drinking water. Here, low arsenic water to be used for cooking, irrigation and drinking while using high arsenic water for bathing and washing. Also, separating between high arsenic and low arsenic is another means to reduce arsenic in drinking water (Saint-Jacques et al 2018). For example, a household may decide to test for arsenic levels in water and paint tube wells using different colours. Moreover, blending low arsenic water with high arsenic water will help to attain a standard concentration level. Lastly, installing arsenic removal systems is a means that ensures relevant dumping of the disposed of arsenic. Although there various efficient and low-cost alternatives for disposing arsenic from family unit provisions, there is no enough verification concerning the degree to which these systems are used efficiently over a certain period.
The world health organization’s (WHO) response to arsenic health problems is working to minimize exposures to arsenic through setting guidelines value and offering risk control recommendations (Baris et al 2016). WHO guidelines for drinking water quality are meant to be used as the basis for regulation standard setting globally. Currently, 10ug/L is the recommended limit of arsenic in drinking water. Yet, hundreds of millions of people around take in arsenic at high concentrations much more than the guide value. This puts them at high risks of arsenic poisoning and hence bladder cancer. Besides, WHO programs for water supply, sanitation and hygiene oversee the developments towards international goals on drinking water. Moreover, the agenda 3030 for sustainable development, the element of “safely managed drinking water services” urges for following populations obtaining drinking water which is free from chemical contaminants.
Research suggests that high exposure to arsenic in drinking water accelerates the risks of bladder cancer by about 40% (Baris et al 2016). However, the molecular means by which arsenic contributes to cancer and the degree to which it causes are still unclear. Comparative genomic hybridization (CGH) is a technique used to discern genetic transformation throughout the genome. This technique enables an evaluation of the transformations in the comparative copy number of DNA sequences. These sequences are discerned through concurrent hybridizing tumour DNA obtained from samples in the clinical tumour and normal tissue.
On the other hand, arsenic poisoning tends to exist in mainly in industrialized areas (Baris et al 2016). Also, high levels of arsenic occur in countries containing groundwater. Arsenate is quickly transported across the gastrointestinal tract after exposure after absorption. arsenate is reduced to arsenate by various enzymes within the liver and other tissues. Inorganic arsenic through methylation produces mono and dimethyl structures that act mainly as a detoxifying process and results from I substance excretion in the urine.
Bladder cancer death rates have continued to increase in various parts of the United States for over half of the country (Mendez et al 2017). High rates of bladder cancer are evident in both men and women with the highest percentage of households using shallow dug wells for drinking water. In most cases, these wells contain low to moderate levels of arsenic. Arsenic is a generated cause of bladder cancer as demonstrated by observations from previous studies. Yet, recent evidence shows that low-moderate levels of arsenic exposure also elevate the risk of bladder cancer.
Arsenic diagnosis should be done by a doctor not only for better treatment but also to help figure out the source and prevent further exposure (Baris et al 2016). Urine measurements are the most reliable tests used in patients with acute exposure within a few days. Although there is no specific method used for treating poisoning arsenic, it is important to eradicate arsenic exposure. Full recovery from arsenic poisoning depends on the period of exposure. However, the severity of the patient’s signs also serves a critical role. Long-term exposures to arsenic lead to various complications including bladder cancer. Groundwater continues to be the leading source of arsenic poisoning. Therefore, drinking clean and filtered water can be the most effective measure against arsenic poisoning.
Moreover, there is a relationship between chromosomal changes in bladder tumours and a person’s exposure to arsenic (Mendez et al 2017). Earlier researches indicate that 10ug/L exposure to arsenic in drinking water accelerates the risk of bladder cancer. The total number of chromosomal changes seemed to be higher with individuals exposed to higher arsenic exposure levels in drinking water. Hence, this illustrates the likelihood of bladder cancer in people who have had long exposure to higher arsenic levels than those exposed to low arsenic levels. This then means as the number of chromosomal changes increases so does the Cancer stage and grade independently of arsenic exposure (Mendez et al 2017). This study shows that patients with high-grade cancers who had been exposed to high arsenic levels experienced high chromosomal changes as compared to those who had low levels of exposure to arsenic. The overall increases in chromosomal changes identified with the increasing exposure to arsenic demonstrate the volatility from the exposure. This volatility promotes and hostile element to bladder cancer for arsenic exposed individuals. Again, this is could be because various chromosomal changes caused by arsenic exposure are also related to the stage and grade of bladder cancer.
Also, for arsenic-exposed individuals, arsenic in drinking water increases gene strengthening in bladder cancer. According to Boffetta, and Borron, (2019). arsenic causes strengthening of the dihydrofolate reductase gene in vitro. However, this might not be the case since high gene amplification levels are uncommon and occur at equal frequencies in bladder cancer for arsenic exposed and non-exposed patients. Findings from this study indicated that bladder cancers from arsenic-exposed patients experienced more chromosomal alterations and hence high genetic instability than their non-exposed counterparts.
Conclusively, this study demonstrated that an increase in arsenic exposure raises both the frequency and specific kinds of genetic changes in bladder cancers. Also, high levels of arsenic exposure increase genetic volatility in bladder cancers perhaps by desynchronizing control pathways of the cell cycle through epigenetic techniques and minimizing the ability of the cell to react appropriately to mend the damaged DNA. This study extracted 50 patients newly diagnosed with bladder cancer. The study, however, exempted patients who had a history of bladder cancer. Data was collected from the urologic oncology database at the University of California. Generally speaking, people are exposed to higher arsenic levels through various ways including the use of contaminated water to prepare food, irrigation of food crops, industrial processes, eating contaminated food and smoking tobacco
References
Baris, D., Waddell, R., Beane Freeman, L. E., Schwenn, M., Colt, J. S., Ayotte, J. D., … & Clerkin, C. (2016). Elevated bladder cancer in Northern New England: the role of drinking water and arsenic. JNCI: Journal of the National Cancer Institute, 108(9).
Boffetta, P., & Borron, C. (2019). Low-level exposure to arsenic in drinking water and risk of lung and bladder cancer: a systematic review and dose-response meta-analysis. Dose-Response, 17(3), 1559325819863634.
Mendez, W. M., Eftim, S., Cohen, J., Warren, I., Cowden, J., Lee, J. S., & Sams, R. (2017). Relationships between arsenic concentrations in drinking water and lung and bladder cancer incidence in US counties. Journal of exposure science & environmental epidemiology, 27(3), 235-243.
Saint-Jacques, N., Brown, P., Nauta, L., Boxall, J., Parker, L., & Dummer, T. J. (2018). Estimating the risk of bladder and kidney cancer from exposure to low levels of arsenic in drinking water, Nova Scotia, Canada. Environment international, 110, 95-104.
Koutras, S., Baris, D., Waddell, R., Beane Freeman, L. E., Colt, J. S., Schwenn, M., … & Stolzenberg‐Solomon, R. (2018). Potential effect modifiers of the arsenic–bladder cancer risk relationship. International journal of cancer, 143(11), 2640-2646.