Interaction between Occupational and Non-Occupational Arsenic Exposure and Tobacco Smoke on Lung Cancerogenesis: A Systematic Review

Giuseppina Folesani, Maricla Galetti, Pier Giorgio Petronini, Paola Mozzoni, Silvia La Monica, Delia Cavallo and Massimo Corradi ()
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Giuseppina Folesani: Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Italian Workers’ Compensation Authority, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
Maricla Galetti: Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Italian Workers’ Compensation Authority, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
Pier Giorgio Petronini: Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
Paola Mozzoni: Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
Silvia La Monica: Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy
Delia Cavallo: Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Italian Workers’ Compensation Authority, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
Massimo Corradi: Department of Medicine and Surgery, University of Parma, Viale Gramsci 14, 43126 Parma, Italy

IJERPH, 2023, vol. 20, issue 5, 1-24

Abstract: Although a higher lung cancer risk has been already associated with arsenic exposure, the contribution of arsenic and its compounds to the carcinogenic effects of other agents, such as tobacco smoke, is not well characterized. This systematic review examined the relationship between occupational and non-occupational arsenic exposure and tobacco smoking on lung cancer risk using papers published from 2010 to 2022. Two databases, PUBMED and Scifinder, were used for the searches. Among the sixteen human studies included, four were about occupational exposure, and the others were about arsenic in drinking water. Furthermore, only three case-control studies and two cohort studies evaluated an additive or multiplicative interaction. The interaction between arsenic exposure and tobacco smoke seems to be negligible at low arsenic concentrations (<100 μg/L), while there is a synergistic effect at higher concentrations. Finally, it is not yet possible to assess whether a linear no-threshold (LNT) model for lung cancer risk can be applied to the co-exposure to arsenic and tobacco smoke. Although the methodological quality of the included studies is good, these findings suggest that rigorous and accurate prospective studies on this topic are highly needed.

Keywords: lung cancer; arsenic exposure; tobacco smoke; synergism; sub-multiplicative interaction; additive interaction (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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