飲用水砷濃度與癌症發生率之劑量效應關係之研究

A study on the dose-response relationship between arsenic concentration in drinking water and incidence of cancer

吳沛穎(Pei-Ying Wu)

指導教授 ： 邱弘毅

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2001年)

摘要

無機砷為已知的致癌物質，許多的研究均指出飲用水中含砷與人體的多種癌症有關。本研究的目的在探討井水高砷濃度地區居民的癌症發生是否顯著高於台灣地區，同時探討無機砷引起各類癌症的劑量效應。 居民的癌症發生資料係取自衛生署的中華民國癌症登記系統，包括1997~ 1999年宜蘭縣礁溪鄉、壯圍鄉、五結鄉、冬山鄉及1992~1999年台南縣北門鄉、學甲鎮、鹽水鎮、下營鄉以及嘉義縣布袋鎮、義竹鄉等十個鄉鎮共111個村里的各類癌症發生個案。井水砷濃度資料係來自台灣大學法醫學科郭宗禮教授1964年至1967年針對嘉義、台南所測量之井水砷濃度及台北醫學大學邱弘毅教授於1991年測量宜蘭地區井水砷濃度之結果。研究之人口資料取自研究地區各鄉鎮戶政事務所的村里人口統計資料。本研究以台灣地區各癌症年齡別發生率為標準發生率，乘以研究地區各鄉鎮同年齡層人口數獲得之期望發生數，再以研究地區各鄉鎮實際發生數除之，獲得之各鄉鎮癌症標準化發生比(SIR)，作為探討井水高砷濃度地區居民癌症發生的指標；進而利用線性迴歸分析探討飲水砷濃度(ppb)與每十萬人癌症發生率之劑量效應。 研究發現宜蘭地區70鄉，胃癌和全癌症男性早期出生世代（>50歲）的標準化發生比(SIR)高於同年齡層台灣地區一般居民，年輕世代（<50歲）與同年齡層台灣地區一般居民相近；另外，嘉義台南地區41個鄉鎮，早期出生世代（>50歲）的皮膚癌、膀胱癌和全癌症標準化發生比(SIR)高於同年齡層台灣地區一般居民，年輕世代（<50歲）與同年齡層台灣地區一般居民相近。劑量效應的探討顯示，宜蘭地區50歲以上男性的肺癌與飲用水砷濃度間呈劑量效應；嘉義台南地區50歲以上男性及合併男女的飲用水砷濃度與肺癌、膀胱癌及全癌症間呈劑量效應。不論男女，皮膚癌均與飲用水砷濃度呈劑量效應；合併研究地區的111個村里分析，男性、女性或是男女合計的皮膚癌和膀胱癌，及男性和男女合計的全癌症均與飲水砷濃度有顯著的劑量效應關係。

關鍵字

砷 ； 標準化發生比 ； 劑量效應關係

並列摘要

Inorganic arsenic is a famous carcinogen, many studies show the relationship of arsenic concentration in drinking water and incidence of human cancer. This study focus on whether the incidence of cancer in high arsenic concentration in wellwater area is significant higher than others in Taiwan, and search for the dose-response relationship about inorganic arsenic induce all kinds of cancers. The incidence of cancer data is according to the cancer record system of Department of Health in Taiwan. The data from 1997 to 1999 is in Chiaoshi, Chuangwei, Tungshan and Wuchien of Ilan County, and from 1992 to 1999 is in Putai, Ichu, Peimen, Yenshi, Hsuechia and Hsiaying of Chiayi and Tainan County. The data of arsenic concentration in wellwater of Chiayi and Tainan County was made from Nation Taiwan University in 1964~1967, and Ilan County was made from Taipei Medical University in 1991. The data of population in this study is according to the information of household registration offices in research area. We used standardized incidence ratios (SIRs) to summarize the observed pattern of incidence in data. SIRs correspond to ratios of observed and expected number of events and are calculated by SOi/Ei, where Oi is the observed number of incidents in the ith age group and Ei is the corresponding expected number on incidents, calculated by multiplying the study population size (p) by the age-specific cancer incidence rate (I) in comparison population (i.e., Ei=Pi*Ii). Usually SIRs are expressed as a percentage so that the value 100*SOi/Ei is the number reported. And we used linear regression to check the dose-response relationship between arsenic concentration in wellwater with cancer incidence rate. The result showed the SIRs of gastric cancer and total cancer in Ilan county is higher than in Taiwan of early birth cohort ( >=50 years), but young cohort is the same with Taiwan area; on the other hand, the SIRs of skin cancer, bladder cancer and total cancer in Chiayi and Tainan County is higher than in Taiwan of early birth cohort ( >=50 years), but young cohort is the same with Taiwan area. The research of dose-response relationship showed that the male over than 50 years in Ilan area is related to lung cancer with arsenic concentration in wellwater; the male over than 50 years in Chiayi and Tainan County is related to lung cancer, bladder cancr and total cancer with arsenic concentration in wellwater, and no matter gender showed dose-response relationship in skin cancer. The analysis of all research areas showed the dose-response relationship between skin cancer and bladder cancer with arsenic concentration in male, female and both of them.

並列關鍵字

arsenic ； standardized incidence ratio ； dose-response relationship

參考文獻

蔡世盟(1998)。”烏腳病社區民眾死亡率及其趨勢分析” 。私立高雄醫學院醫學研究所博士論文:p16。

參考文獻 Andreae MO. Distribution and speciation of arsenic in natural water and some marine algal. Deep Sea Res 1978; 25: 391-402.

Bates M N, Smith A H, Cantor K P. Case-control study of bladder cancer and arsenic in drinking water. Am J Epidemiol 1995; 141: 523-29.

Bates MN, Smith AH, Cantor KP. Case-control study of bladder cancer and Arsenic in drinking water. Am J Epidemiol 1995; 141: 523-30.

Bulbulyan M A, Jurenkova N J, Boffetta P, Astashevsky S V, Mukeria A F, Zaridze D G. Mortality in a cohort of Russian fertilizer works. Scand J Work Environ Health 1996; 22: 27-33.