Nuevas evidencias sobre los

efectos crónicos de la

exposición a arsénico en agua

potable en Chile.

Catterina Ferreccio ReadiDepartamento de Salud Pública

www.saludpublicauc.cl

Pontificia Universidad Católica de ChileSantiago 2013

Regiones del Norte de Chile

Lugar más

seco del

mundo

Pocas fuentes

de aguaTodos toman

agua de la misma

fuente

Hay registros históricos de

los niveles de As en todas las

fuentes de agua

+

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

Prom ajustado de As ( g/L) agua Reg II, 50-94

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

Late fetal mortality rates for Antofagasta and

Valparaiso, 1950 to 1996. Environmental Health Perspectives

0.5

1

1.5

2

1950 1960 1970 1980 1990 2000

Year

Rate

Rati

os

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.

Exposición

niñezExpuesto sólo

como adultos

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.

Evidence From Chile That Arsenic in

Drinking Water May Increase Mortality From

Pulmonary Tuberculosis

American Journal of Epidemiology

Mortality in young adults following in utero and

early childhood exposure to arsenic in drinking

water

RIESGO DE CANCER PULMONAR INTERACCION

ARSENICO/TABACO. Casos y Controles. 1994-1996

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

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.

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

carcinogen1.8 (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

fumes1.0 (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)

Kidney Cancer OR by As Intake and Histologic

Subtype, Chile, 2007-10

Type of cancer Renal pelvis & ureter Renal cell

ExposureAs

intake Contr Case OR 95% CI

No.

CasesOR 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

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

FVC103.6 ± 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

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

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?

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