A LARGE systematic review and meta-analysis has found that environmental exposure to certain nonessential elements, particularly arsenic, cadmium and vanadium, is associated with an increased risk of urologic cancers, though substantial heterogeneity limits causal interpretation.
Researchers analysed 68 cohort and case-control studies (62 included in quantitative synthesis) identified from multiple international databases up to January 2026, encompassing more than 23,000 screened records. The analysis compared highest versus lowest exposure categories and assessed dose-response relationships across urologic cancer types, including bladder, prostate, kidney, urinary tract and testicular cancers.
Arsenic Shows the Strongest Association with Urologic Cancer
Arsenic exposure showed the strongest and most consistent associations. Compared with the lowest exposure group, the highest exposure was associated with a 72% increased risk of overall urologic cancer (RR 1.72, 95% CI 1.33–2.22). Significant associations were also observed for bladder cancer (RR 1.60), prostate cancer (RR 1.19) and urothelial carcinoma (RR 3.37). No significant association was found for kidney cancer (RR 1.38, 95% CI 0.76–2.52). A nonlinear dose–response relationship was identified for drinking-water arsenic concentrations above 10 µg/L, with risk increasing progressively up to 429 µg/L.
Using population attributable fraction modelling, the authors estimated that reducing drinking-water arsenic concentrations to 10 µg/L could avert between 0.1 and 31.8 cases per 100,000 population annually in high-exposure regions.
For other elements, cadmium exposure was associated with a 38% increased risk of overall urologic cancer (RR 1.38, 95% CI 1.04–1.82), while vanadium showed a smaller but significant association (RR 1.15, 95% CI 1.05–1.26). Evidence for lead, nickel and other elements remained limited and inconsistent.
Study Limitations and Need for Further Research
The authors note that high between-study heterogeneity, differences in exposure assessment and study design constrain the strength of causal inference. Nonetheless, the findings support a potential role for environmental metal exposure in urologic carcinogenesis and underscore the need for well-designed prospective studies and improved exposure quantification.
Public health implications include the potential benefit of stricter environmental regulation, particularly for arsenic in drinking water, to reduce urologic cancer burden in high-exposure populations, particularly highlighting environmental health disparities and the importance of global water safety standards. Causality remains unproven, pending further longitudinal evidence in diverse populations.
Reference
Deng Z et al. Environmental Nonessential Element Exposure and Urologic Cancer: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2026; 9(5):e2614337.
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