Article Association of arsenic with recurrence of urinary bladder cancer Dilip K Pal 1 , Akash Agrawal 2 , Sabnam Ghosh 3 and Amlan Ghosh 4 Abstract Arsenic is known to be an important aetiological factor for the development of urinary bladder cancer. It is known to be found excessively in ground water in certain geographical areas, including West Bengal. We have studied patients with recurrent bladder cancer from different areas of this Indian state and correlated arsenic as a causative aetiological factor for development and aggressiveness of the biological behaviourof urinary cancer. We included 31 patients from various parts of West Bengal state with recurrent bladder cancer who were operated in our institute. Their clinical and resi- dential data and their arsenic content of tumour tissue were measured. Statistical analysis was performed to test the association of tissue arsenic with clinicopathological features of recurrent disease. We found very high levels of arsenic in tumour tissue in all residents of the districts with high prevalence of arsenic in the drinking water. We also observed more aggressive clinicopathological progression and early recurrence in patients with high arsenic content. We conclude that arsenic is a causal factor in the clinicopathological progression of recurrent urinary bladder cancer. Measures to decrease the level of arsenic in drinking water should be taken as this may both improve clinicopathological outcomes in the recurrence of urinary bladder carcinoma, as well as reducing its overall incidence. Keywords Arsenic, bladder cancer, recurrent bladder tumour, smoking Introduction Urinary bladder cancer is strongly associated with environmental exposure of carcinogens. This associ- ation is especially strong for arsenic, which has been shown to induce malignant transformation of the urothelium. It correlates to the endemic areas where populations were identified with arsenic-induced skin cancer. 1,2 Excess inorganic arsenic in drinking water from artesian wells is implicated as the commonest route of exposure, 3–5 though environmental, agricul- tural and occupational roles may also be significant. Distribution of arsenic in West Bengal is shown in Figure 14. According to a report submitted by the School of Environmental Studies, Jadavpur University, on the contamination of ground water in West Bengal, five districts (Bankura, Birbhum, Purulia, Medinipur East and Medinipur West) were unaffected or arsenic safe (arsenic concentration < 10 mg/L), five (Koch Bihar, Jalpaiguri, Darjiling, North Dinajpur and South Dinajpur) were mildly affected (arsenic concentrations 11–50 mg/L) and the remaining nine (Malda, Murshidabad, Nadia, North-24 Parganas, South-24 Parganas, Barddhaman, Haora, Hugli and Kolkata) were severely affected (arsenic concentrations > 50 mg/ L). 6 This is shown in Figure 1. Our study detects the presence of arsenic in tumour tissue in cases of recurrent bladder cancer and its rela- tion to arsenic levels in the water at the home of the patient. We looked at the recurrence interval, stage pro- gression, and grade of tumour and the association with the arsenic content in tumour tissue. Although tumour 1 Professor and Head, Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India 2 Postdoctorate Trainee, Department of Urology, Institute of Post Graduate Medical Education & Research, Kolkata, India 3 PhD Scholar, Department of Life Sciences, Kolkata, India 4 Assistant Professor, Department of Life Sciences, Presidency University, Kolkata, India Corresponding author: Dilip K Pal, Professor and Head, Department Urology, Institute of Post Graduate Medical Education and Research, Kolkata 700020, India. Email: urologyipgmer@gmail.com Tropical Doctor 0(0) 1–5 ! The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0049475520930155 journals.sagepub.com/home/tdo