MULTIPLE RISK-FACTORS ASSOCIATED WITH ARSENIC-INDUCED SKIN-CANCER - EFFECTS OF CHRONIC LIVER-DISEASE AND MALNUTRITIONAL STATUS

In order to evaluate the prevalence and multiple risk factors of arsen ic-induced skin cancer among residents in Taiwanese villages in which chronic arseniasis is hyperendemic, a total of 1571 subjects aged 30 o r more years were recruited between September 1988 and March 1989. All of them were interviewed personally by a public health nurse using a structured questionnaire, and 1081 interviewed study subjects, includi ng 468 men and 613 women, participated in physical examination, giving a participation rate of 68.8%. The overall prevalence of skin cancer was as high as 6.1%, showing an increase with age in both men and wome n. There was a significant dose-response relation between skin cancer prevalence and chronic arsenic exposure as indexed by duration of resi dence in the endemic area, duration of consumption, of high-arsenic ar tesian well water, average arsenic exposure in parts per million (p.p. m.) and cumulative arsenic exposure in p.p.m.-years. Chronic carriers of hepatitis B surface antigen with liver dysfunction had an increased prevalence of skin cancer. Undernourishment, indexed by a high consum ption of dried sweet potato as a staple food, was also significantly a ssociated with an increased prevalence of arsenic-induced skin cancer. All these risk factors remained statistically significant in the mult iple logistic regression analysis. Consistent with animal experiments, the findings imply that liver function and nutritional status may aff ect the metabolism of inorganic arsenic and the development of subsequ ent skin cancers.