Low-Level Exposure to Arsenic in Drinking Water and Risk of Lung and Bladder Cancer: A Systematic Review and Dose–Response Meta-Analysis

Background: Exposure to high levels of arsenic in drinking water has been associated with an increased risk of lung and bladder cancer, but the presence of an increased risk at low levels is questionable. Methods: A systematic review and a dose–response meta-analysis were conducted on risk estimates of lung and bladder cancer for exposure to arsenic in drinking water up to 150 µg/L, using a 2-stage approach based on a random-effects model. Results: Five studies of lung cancer were identified; the meta-relative risk (RR) for an increase of 10 µg/L arsenic level was 1.03 (95% confidence interval [CI]: 0.99-1.06; P heterogeneity =.05). The meta-analysis of bladder cancer included 8 studies; the meta-RR for an increase of 10 µg/L arsenic level was 1.02 (95% CI: 0.97-1.07, P heterogeneity =.01). Sensitivity analyses, including a 1-stage meta-regression, confirmed the main findings. Conclusion: This systematic review and meta-analysis provided evidence of a lack of an increased risk of lung and bladder cancer for exposure to arsenic in drinking water up to 150 µg/L, the highest concentration studied.