背景：砷已被證實為人類致癌物，過去台灣的研究指出砷與皮膚、肺、肝、膀胱及腎臟癌有顯著的劑量效應關係。但是關於砷與前列腺癌的研究並沒有一致性的結果，除此之外國內缺乏砷與前列腺癌發生率的相關研究。因此本研究目的是要探討台灣地區飲水含砷與前列腺癌及膀胱癌的相關性。
方法：本研究是以台灣243鄉鎮為對象的生態研究，癌症個案資料及死亡資料分別取自1980至2003年的癌症登記資料庫以及死因資料庫，並以ICD9做為癌症分類依據；而飲水含砷資料取自於政府所策劃的井水檢測大調查。本研究利用直接年齡標準化及間接年齡標準化指標來分析烏腳病流行地區、台南嘉義地區及台灣其他地區膀胱癌及前列腺癌其發生率與死亡率，另外以多變項線性迴歸模式來分析飲水含砷與膀胱癌及前列腺癌的相關性，該迴歸模式的自變項為各個鄉鎮在不同砷井水濃度的井口數百分比，依變項為各鄉鎮的直接年齡標準化發生率(directed-standardized incidence rates)。
結果：本研究結果顯示，無論男性或是女性，烏腳病流行地區膀胱癌標準化發生率及死亡率皆明顯高於台南嘉義地區及台灣其他地區。暴露到飲水含砷濃度大於0.64 mg/L會增加膀胱癌發生率的危險性，也會增加膀胱癌死亡率的危險性，兩者皆達到統計顯著意義(P<0.01)，但其餘的砷濃度階層皆無相關。烏腳病流行地區前列腺癌標準化發生率低於台灣其他地區，死亡率則高於台灣其他地區，進一步分析發現飲水含砷與前列腺癌之間無相關性。
結論：膀胱癌與飲水含砷的相關性與先前的研究有相同的結論，然而本研究發現前列腺癌與飲水含砷之間是沒有相關的。

Background: Arsenic has been documented as a human carcinogen, and significant dose-response relationships between ingested arsenic and cancers of the skin, lung, liver, bladder, and kidney have been reported in Taiwan. However, results of studies on the association between arsenic ingestion and prostate cancer are inconsistent. The objective of this study was to examine the association between prostate, and bladder cancers and arsenic in drinking water in Taiwan.
Method: We conducted an ecologic study encompassing 243 townships and collected data on cancer patients between 1980 and 2003 using the national cancer registry and death registration. Reports from a nationwide census survey of wells conducted by the government were applied to assess the arsenic levels in drinking water. We used direct and indirect standardizations to evaluate the occurrence of cancers in the blackfoot disease endemic area, Tainan and Chiayi area and other areas in Taiwan. Then we applied multivariate linear regression models to analyze the age-adjusted standardized incidence rates (ASIRs) and age-adjusted standardized mortality rates (ASMRs) of prostate and bladder cancers using the percentages of wells with various specified arsenic levels in each township as the exposure variables.
Result: SMRs and SIRs of bladder cancer are consistently higher in BFD endemic areas, and we observed a positive association between the highest arsenic exposure category (>0.64 mg/L) and bladder cancer in both men and women, but there was no association between arsenic level and prostate cancer. The BFD endemic area had lower ASIRs but higher ASMRs of prostate cancer than other areas in Taiwan, and there was no association between arsenic in drinking water and prostate cancer.
Conclusion: While our findings on bladder cancer are consistent with those reported by previous studies, we did not observe an association between arsenic ingestion and prostate cancer.

APHA (American Public Health Association). 1985.
Standard Methods of the Evaluation of Water and Water
Waste. American Public Health Association, Washington
, DC.
Basstrup R, Sorensen M, Balstrom T et al. 2008. Arsenic
in drinking-water and risk for cancer in Denmark.
Environ Health Perspect 116(2):231-237.
Besuschio SC, Perez Desanzo AC, Croci M. 1980.
Epidemiology associations between arsenic and cancer
in Argentina. Biol Trace Elem Res 2:41-55.
Bhattacharyya R, Chatterjee D, Nath B, Jana J, Jacks G,
Vahter M. 2003. High arsenic groundwater:
mobilization, metabolism and mitigation--an overview
in the Bengal Delta Plain. Mol Cell Biochem 253:347-355.
Chen CJ, Chuang YC, Lin TM, Wu HY. 1985. Malignant
neoplasms among residents of a blackfoot
disease-endemic area in Taiwan: high-arsenic artesian
well water and cancers. Cancer Res 45:5895-5899.
Chen CJ, Wang CJ. 1990. Ecological correlation between
arsenic level in well water and age-adjusted mortality
from malignant neoplasms. Cancer Res 50:5470-5474.
Chen CJ, Wu MM, Lee SS, Wang JD et al. 1988a.
Atherogenicity and carcinogenicity of high-arsenic
artesian well water. Arteriosclerosis 8(5):452-460.
Chen CJ, Kuo TL, Wu MM. 1988b. Arsenic and cancers.
Lancet: 414-415.
Chen IJ, Chen CW, Guo HR, Lin MS, Hsiue TR. 2003. The
value of carcinoembryonic antigen differentiating
malignant from benign pleural effusion. Thoracic
Medicine 18:110-115.
Chen KP, Wu HY, Wu TC. 1962. Epidemiology studies on
blackfoot disease in Taiwan. 3. Physicochemical
characteristics of drinking water in endemic blackfoot
disease area. Mem Coll Med Natl Taiwan Univ 8:115-119.
Chiou JM, Wang SL, Chen CJ, Deng CR, Lin Wender, and Tai
TY. 2005. Arsenic ingestion and increased microvascular
disease risk: observations from the southwestern
arseniasis-endemic area in Taiwan. Int J Epidemiol
34:936-943.
Crawford ED. 2003. Epidemiology of prostate cancer.
Urology 62:3-12.
Enterline PE, Marsh GM. 1982. Cancer among workers
exposed to arsenic and other substances in a copper
smelter. Am J Epidemiol 116(6):895-911.
Enterline PE, Day R, Marsh GM. 1995. Cancers related
to exposure to arsenic at a copper smelter. Occup
Environ Med 52(1):28-32.
Gustavsson P, Gustavsson A, and Hogstedt C. 1988. Excess
of cancer in Swedish chimney sweeps. Br J Ind Med
45(11):777-781.
Guo HR, Chiang HS, Hu H et al. 1997. Arsenic in drinking
water and incidence of urinary cancers.
Epidemiology 8(5):545-550.
Guo HR, Chen CJ, Greene HL. 1994. Arsenic in drinking
water and cancers: a brief descriptive review of Taiwan
studies. Environ. In: Chappell WR, Abernathy CO,
Cothern CR (eds.) Arsenic Exposure and Health.
Science and Technology Letters, Northwood, pp. 129-138.
Guo HR, Lipsitz SR, Hu H, Monson RR. 1998. Using ecological
data to estimate a regression model for individual data:
the association between arsenic in drinking water and
incidence of skin cancer. Environ Res 79:82-93.
Guo HR, Yu HS, Hu H, Monson RR. 2001. Arsenic in drinking
water and skin cancer: cell-type specificity. Cancer
Causes Control 12:909-916.
Guo HR, Wang NS, Hu H, Monson RR. 2004. Cell-type
specificity of lung cancer associated with arsenic
ingestion. Cancer Epidemiol Biomarkers Prev 13:638-643.
Hinwood AL, Jolley DJ, Sim MR. 1999. Cancer incidence
and high environmental arsenic concentrations in rural
populations: results of an ecological study.
Int J Environ Health Res 9(2):131-141.
Hutchinson J. 1887. Arsenic cancer.
British Medical Journal 2:1280-1281.
Kaltreider RC, Davis AM, Lariviere JP, Hamilton JW.
2001. Arsenic alters the function of the glucocorticoid
receptor as a transcription factor. Environ Health Perspect
109:245–251.]
Lweis DR, Southwick JW, Ouellet-Hellstrom R et al. 1999.
Drinking water arsenic in Utah: A cohort mortality study.
Environ Health Perspect 107(5):359-365.
Lo MC, Hsen YC, Lin KK. 1977. Second Report on the
Investigation of Arsenic Content in Underground Water in
Taiwan. Taichung, Taiwan: Taiwan Provincial Institute of
Environmental Sanitation.
Mabuchi K, Lilienfeld AM, Snell LM. 1980. Cancer and
occupational exposure to arsenic: a study of pesticide
workers. Prev Med 9:51-77.
NIOSH. 1975. Criteria Document: Inorganic Arsenic DHEW Pub.
NIOSH pp. 75-149.
Sommers SC, McManus RG. 1952. Multiple arsenical cancers of
skin and internal organs. Cancer 6:347-459.
Sobel W, Bond GG, Baldwin CL et al. 1988. An update of
respiratory cancer and occupational exposure to arsenicals.
Am J Ind Med 13(2):263-270.
Smith AH, Hopenhayn-Rich C, Bates MN et al. 1992. Cancer
risks from arsenic in drinking water. Environ Health
Perspect 97:259-267.
Tchounwou PB, Wilson B. 1999. Isaque A. Important
considerations in the development of public health advisories
for arsenic and arsenic-containing compounds in drinking water.
Review on environmental Health 14:211-229.
Tseng WP, Chu HM, How SW et al. 1968. Prevalence of skin cancer
in an endemic area of chronic arsenicism in Taiwan. J Natl
Cancer Inst 40:453-463.
Tseng WP. 1989. Blackfoot disease in Taiwan: a 30-year follow-up
study. J Vasc Dis 7:547-558.
Tsai SM, Wang TN, Ko YC. 1999. Mortality for certain disease
in areas with high levels of arsenic in drinking water.
Arch Environ Health 54(3):186-193.
Tsuda T, Nagira T, Yamamoto M et al. 1990. An epidemiology
study on cancer in certified arsenic poisoning patients in
Toroku. Ind Health 28(2):53-62.
Tsuda T, Babazono A, Yamamoto E et al. 1995. Ingested arsenic
and internal cancer: a historical cohort study followed for
33 years. Am J Epidemiol 141:198-209.
U.S. Environmental Protection Agency. 1980. Ambient Water
Quality Criteria Doc: Arsenic EPA 440/5-84-033.
U.S. Environmental Protection Agency. 1988. Special report on
ingested inorganic arsenic. Washington DC: EPA.
Vahter M. 2000. Genetic polymorphism in the biotransformation
of inorganic arsenic and its role n toxicity. Toxicol
Lett 112-113: 209-217.
Vahter M. 2004. Species difference in the metabolism of arsenic
compounds. Applied Organometallic Chemistry 8: 175-182.
Vahter M. 1999. Methylation of inorganic arsenic in different
mammalian species and population groups. Sci. Prog 82: 69-88.
Wang YW, Leung WH, Lu PL, Guo HR. 2003. Pre-operative low dose
radiotherapy of rectal cancer with Founier’s gangrene: A case
report and review of literature. Therapeutic Radiology and
Oncology 10:181-187.
World Health Organization. 1987. Environmental Health Criteria: Arsenic.
World Health Organization. 1993. Guideline for Drinking Water
Quality, Vol 1, Recommendations.
Wu HY, Chen KP, Tseng WP, et al. 1961. Epidemiology studies on
blackfoot disease. 1. Prevalence and incidence of the disease
by age, sex, year, occupation, and geographic distribution.
MemColl Med Natl Taiwan Univ 7:33-50.
Wu MM, Kuo TL, Hwang YH et al. 1989. Dose-response relation
between arsenic concentration in well water and mortality from
cancers and vascular diseases. Am J Epidemiol 130(6):1123-1132.
郭浩然：飲水含砷量與膀胱癌死亡率的劑量效應關係。中華衛誌 18(6)
附冊1：134-139，1999。
徐毓蘭等：水中砷處理技術應用。經濟部環保技術e報，第055期，2008
行政院環境保護署飲用水水質標準。中華民國九十四年五月三十日 行政院環境
保護署環署毒字第0940039894號。
廖勇柏、陳建仁、李文宗、游山林、徐書儀等：中華民國癌症死亡率分佈地圖集
民國61年至90年。台北，行政院衛生署國民健康局，2003。
陳建仁、廖勇柏、游山林、李文宗、徐書儀等：中華民國癌症發生率分佈地圖集
民國84年至87年。台北，行政院衛生署國民健康局，2003。