Letter to the Editor
Hexavalent chromium and bladder cancer risk
Como hexavalente y riesgo de cáncer de vejiga
K. Stamatiou
Stamatiou Departamento de Cirugía y Urología, Hospital General de Tebas, Tebas, Greece
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"apellidos" => "Villavicencio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480611002427" "doi" => "10.1016/j.acuro.2011.06.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480611002427?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578612000856?idApp=UINPBA00004N" "url" => "/21735786/0000003600000003/v1_201304251809/S2173578612000856/v1_201304251809/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Hexavalent chromium and bladder cancer risk" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "199" "paginaFinal" => "200" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "K. Stamatiou" "autores" => array:1 [ 0 => array:3 [ "nombre" => "K." "apellidos" => "Stamatiou" "email" => array:1 [ 0 => "stamatiouk@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Stamatiou Departamento de Cirugía y Urología, Hospital General de Tebas, Tebas, Greece" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Como hexavalente y riesgo de cáncer de vejiga" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have recently completed a study on the follow-up of patients with superficial bladder carcinoma. This controlled prospective study took place at the General Hospital of Thebes (Viotia, Greece) from April 2006 to February 2009. More precisely, the study group included a total of 45 patients who had a recent history of recurrent superficial bladder cancer and subsequent TUR-BTs. Upon the completion of the study we realized that the 42% recurrence rate observed in our sample is unusually high, given that it actually represents the recurrences in the time between two cystoscopies. The reasons explaining this finding are practically unknown. It could be hypothesized that it may be due to the relatively large number of high risk bladder cancer patients (no. 7). Another reason explaining the high recurrence rate could be the fact that all the patients are from the cities of Thiva, Inofyta and Schimatari, (Thiva-Tanagra-Malakasa basin, Eastern Sterea Ellada, Greece), which support many industrial activities. According to our investigations, all the subjects with a confirmed bladder cancer recurrence consume tap water. Concentrations of chromium (up to 80<span class="elsevierStyleHsp" style=""></span>mg/L Cr(VI)) have recently been found in the urban water supply of Inofyta city. Cr(VI) concentrations ranging from 5 to 33<span class="elsevierStyleHsp" style=""></span>mg/L were found in groundwater that is used for Thiva's water supply. Arsenic concentrations up to 34<span class="elsevierStyleHsp" style=""></span>mg/L along with Cr(VI) levels up to 40<span class="elsevierStyleHsp" style=""></span>mg/L were detected in Schimatari's water supply.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hexavalent chromium is a potent carcinogen and previous studies have shown that it causes lung cancer in humans in certain occupational settings as a result of inhalation exposure.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> So far as we know, carcinogen exposure via consumption of drinking water has been investigated previously and is potentially of importance. In fact, the use of drinking water contaminated by nitrate, hexavalent chromium, and other heavy metals from industrial discharges has been associated with carcinogenesis,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> and a large American study has found that drinking more fluids is associated with a significantly decreased rate of bladder cancer.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Interestingly, a more focused experimental study demonstrated that hexavalent chromium can cause bladder cancer in animals when administered orally.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The specific mechanism remains unclear; however, it might be associated to tap water concentrations of heavy metals. This urogenous-contact hypothesis could play a role in Greece since the warm climate favors dehydration which itself increases the urine concentration.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Actually, an older epidemiologic study in the above region demonstrated that cancer mortality in this area is 14% higher than in other areas of Viotia, the prefecture in which it is located. Alarmingly, it also showed that the incidence of cancer fatalities had increased by 90% in 2009 alone, and deaths from cancer of the urinal tract are 841% higher than similar fatalities elsewhere in Viotia.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Against a background of increased knowledge and interest in bladder cancer specific pathophysiology, our knowledge on epidemiology and risk factors is still limited and the exact genetic events leading to the development of bladder cancer remain unknown. According to the current knowledge, cigarette smoking and occupational exposure have been recognized as risk factors<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> while cyclophosphamide treatment and urothelial trauma have been -only- proposed to be.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> The only well established carcinogens are alpha- and beta-naphthylamine, benzidine, and 4-aminobiphenyl.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Currently, it is not known whether hexavalent chromium promotes bladder cancer development and if the drinking of contaminated water is linked to its recurrence. However, there is no doubt about the urgent need for a better understanding of the early phase/initiation of bladder cancer in view of all the potential carcinogenic substances in order to decrease the high prevalence of the disease. Epidemiologic investigations should consider the complex pathogenesis of bladder cancer and the fact that many patients are in contact with multiple potential carcinogenic agents. Ideally, this would require a prospective multicenter data collection/analysis based on a standardized database including a strict defined patient cohort with detailed patients history and a long follow-up.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Considering the abovementioned study regarding the overall cancer prevalence in the cities of Thiva, Inofyta and Schimatari, we do believe that epidemiologic studies are also necessary to assess the prevalence of bladder cancer in the region above.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Stamatiou K. Como hexavalente y riesgo de cancer de vejiga. Como hexavalente y riesgo de cáncer de vejiga. Actas Urol Esp. 2012;36:199–200.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hexavalent chromium. and other toxic elements in natural waters in the Thiva-Tanagra-Malakasa Basin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Vasilatos Ch" 1 => "I. Megremi" 2 => "M. Economou-Eliopoulos" 3 => "I. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2018 February | 3 | 5 | 8 |
| 2018 January | 10 | 0 | 10 |
| 2017 December | 5 | 2 | 7 |
| 2017 November | 13 | 5 | 18 |
| 2017 October | 11 | 4 | 15 |
| 2017 September | 10 | 1 | 11 |
| 2017 August | 13 | 4 | 17 |
| 2017 July | 13 | 3 | 16 |
| 2017 June | 9 | 21 | 30 |
| 2017 May | 10 | 7 | 17 |
| 2017 April | 28 | 12 | 40 |
| 2017 March | 23 | 15 | 38 |
| 2017 February | 16 | 4 | 20 |
| 2017 January | 13 | 1 | 14 |
| 2016 December | 21 | 11 | 32 |
| 2016 November | 28 | 4 | 32 |
| 2016 October | 36 | 11 | 47 |
| 2016 September | 26 | 11 | 37 |
| 2016 August | 17 | 8 | 25 |
| 2016 July | 13 | 1 | 14 |
| 2016 June | 21 | 11 | 32 |
| 2016 May | 15 | 31 | 46 |
| 2016 April | 28 | 13 | 41 |
| 2016 March | 29 | 14 | 43 |
| 2016 February | 32 | 23 | 55 |
| 2016 January | 22 | 20 | 42 |
| 2015 December | 17 | 9 | 26 |
| 2015 November | 13 | 9 | 22 |
| 2015 October | 18 | 7 | 25 |
| 2015 September | 18 | 5 | 23 |
| 2015 August | 17 | 14 | 31 |
| 2015 July | 12 | 6 | 18 |
| 2015 June | 8 | 7 | 15 |
| 2015 May | 5 | 7 | 12 |
| 2015 April | 13 | 7 | 20 |
| 2015 March | 21 | 5 | 26 |
| 2015 February | 5 | 7 | 12 |
| 2015 January | 24 | 8 | 32 |
| 2014 December | 40 | 17 | 57 |
| 2014 November | 21 | 3 | 24 |
| 2014 October | 39 | 10 | 49 |
| 2014 September | 40 | 4 | 44 |
| 2014 August | 38 | 3 | 41 |
| 2014 July | 34 | 6 | 40 |
| 2014 June | 27 | 5 | 32 |
| 2014 May | 15 | 2 | 17 |
| 2014 April | 17 | 5 | 22 |
| 2014 March | 21 | 3 | 24 |
| 2014 January | 6 | 1 | 7 |
| 2013 December | 19 | 3 | 22 |
| 2013 November | 11 | 3 | 14 |
| 2013 October | 26 | 4 | 30 |
| 2013 September | 13 | 1 | 14 |
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