LAUSR

Introduction Cholangiocarcinoma (CCA) is an aggressive tumor occurring in bile ducts and associated with dismal outcomes. It can be classified according to anatomical location as intrahepatic cholangiocarcinoma (ICC) or extrahepatic cholangiocarcinoma (ECC). Although some risk factors have been identified, our understanding of these tumors remains limited. Arsenic (As) is a prevalent toxicant with established associations with bladder, skin and lung cancers while pilot data on its potential carcinogenic role on digestive tumors are emerging. This ecological study aimed to investigate the association between exposure to As-contaminated drinking water and CCA. Methods Analyses were conducted for the US, Taiwan and India due to the quality of publicly available datasets including small area-level information. Statistics included coefficient correlations analyses as well as univariate and multivariate linear regressions. Results In the US, no correlation was observed between As and CCA. In Taiwan, correlations were identified for ICC in men (Spearman = 0.55, P = 0.01) and women (Spearman = 0.67, P < 0.01), as well as for ECC in men (Spearman = 0.62, P < 0.01). In India, counties with As level of at least 50 µg/L showed higher incidences of ECC in men (R2 = 0.26, P = 0.01) and women (R2 = 0.31, P < 0.01). Conclusion These findings highlighted a potential carcinogenic impact of As in drinking water on bile duct cancers, paving the way for future studies aiming to replicate this association with individual data as well as its clinical and ecological implications.