Cadmium Exposure and Cancer Mortality in a Prospective Cohort: The Strong Heart Study
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Citation: García-Esquinas E, Pollan M, Tellez-Plaza M, Francesconi KA, Goessler W, Guallar E, Umans JG, Yeh J, Best LG, Navas-Acien A. Cadmium Exposure and Cancer Mortality in a Prospective Cohort: The Strong Heart Study. Environ Health Perspect; http://dx.doi.org/10.1289/ehp.1306587.
Received: 30 January 2013
Accepted: 10 December 2013
Advance Publication: 14 February 2014
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Background: Cadmium is a toxic metal classified as a human carcinogen by the International Agency for Research on Cancer.
Objective: To evaluate the association of long-term cadmium exposure, as measured in urine, with cancer mortality in American Indians from Arizona, Oklahoma and North/South Dakota who participated in the Strong Heart Study in 1989-91.
Methods: Prospective cohort study of 3,792 men and women 45-74 years of age who were followed for up to 20 years. Baseline urine cadmium was measured using inductively coupled plasma mass spectrometry. We assessed cancer events by annual mortality surveillance.
Results: Median (interquintile range) urine cadmium concentration was 0.93 (0.55, 1.63) µg/g creatinine. After adjustment for sex, age, smoking status, cigarette pack-years, and body mass index, adjusted hazard ratios comparing the 80th versus 20th percentiles of urine cadmium were 1.30 (95% CI: 1.09, 1.55) for total cancer, 2.27 (95% CI: 1.58, 3.27) for lung cancer, and 2.40 (95% CI: 1.39, 4.17) for pancreas cancer mortality. For all smoking-related cancers combined, the corresponding hazard ratio was 1.56 (95% CI: 1.24, 1.96). Cadmium was not significantly associated with liver, esophagus and stomach, colon and rectum, breast, prostate, kidney, or lymphatic and hematopoietic cancer mortality. Based on mediation analysis, we estimated the percentage of lung cancer deaths due to tobacco smoking that could be attributed to cadmium exposure was 9.0% (95%CI: 2.8, 21.8%).
Conclusions: Low to moderate cadmium exposure was prospectively associated with total cancer mortality and with mortality from cancers of the lung and pancreas. The implementation of population-based preventive measures to decrease cadmium exposure could contribute to reducing the burden of cancer.
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