Research article Special Issues

G.I.S. Surveillance of Chronic Non-occupational Exposure to Heavy Metals as Oncogenic Risk

  • Introduction: The potential oncogenic effect of some heavy metals in people occupationally and non-occupationally exposed to such heavy metals is already well demonstrated. This study seeks to clarify the potential role of these heavy metals in the living environment, in this case in non-occupational multifactorial aetiology of malignancies in the inhabitants of areas with increased prevalent environmental levels of heavy metals. Methods: Using a multidisciplinary approach throughout a complex epidemiological study, we investigated the potential oncogenic role of non-occupational environmental exposure to some heavy metals [chrome (Cr), nickel (Ni), copper (Cu), zinc (Zn), cadmium (Cd), lead (Pb) and arsenic (As)—in soil, drinking water, and food, as significant components of the environment] in populations living in areas with different environmental levels (high vs. low) of the above-mentioned heavy metals. The exposures were evaluated by identifying the exposed populations, the critical elements of the ecosystems, and as according to the means of identifying the types of exposure. The results were interpreted both epidemiologically (causal inference, statistical significance, mathematical modelling) and by using a GIS approach, which enabled indirect surveillance of oncogenic risks in each population. Results: The exposure to the investigated heavy metals provides significant risk factors of cancer in exposed populations, in both urban and rural areas [χ² test (p < 0.05)]. The GIS approach enables indirect surveillance of oncogenic risk in populations. Conclusions: The role of non-occupational environmental exposure to some heavy metals in daily life is among the more significant oncogenic risk factors in exposed populations. The statistically significant associations between environmental exposure to such heavy metals and frequency of neoplasia in exposed populations become obvious when demonstrated on maps using the GIS system. Environmental surveillance of heavy metals pollution using GIS should be identified as an important element of surveillance, early detection, and control of neoplastic risks in populations, at the level of a single locality, but even on a wider geographical scale.

    Citation: Ioan Stelian Bocşan, Irina Brumboiu, Tudor Călinici, Mariana Vlad, Cecilia Roman, Ioana Brie, Mihaela Lucia Ponta. G.I.S. Surveillance of Chronic Non-occupational Exposure to Heavy Metals as Oncogenic Risk[J]. AIMS Public Health, 2016, 3(1): 54-64. doi: 10.3934/publichealth.2016.1.54

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  • Introduction: The potential oncogenic effect of some heavy metals in people occupationally and non-occupationally exposed to such heavy metals is already well demonstrated. This study seeks to clarify the potential role of these heavy metals in the living environment, in this case in non-occupational multifactorial aetiology of malignancies in the inhabitants of areas with increased prevalent environmental levels of heavy metals. Methods: Using a multidisciplinary approach throughout a complex epidemiological study, we investigated the potential oncogenic role of non-occupational environmental exposure to some heavy metals [chrome (Cr), nickel (Ni), copper (Cu), zinc (Zn), cadmium (Cd), lead (Pb) and arsenic (As)—in soil, drinking water, and food, as significant components of the environment] in populations living in areas with different environmental levels (high vs. low) of the above-mentioned heavy metals. The exposures were evaluated by identifying the exposed populations, the critical elements of the ecosystems, and as according to the means of identifying the types of exposure. The results were interpreted both epidemiologically (causal inference, statistical significance, mathematical modelling) and by using a GIS approach, which enabled indirect surveillance of oncogenic risks in each population. Results: The exposure to the investigated heavy metals provides significant risk factors of cancer in exposed populations, in both urban and rural areas [χ² test (p < 0.05)]. The GIS approach enables indirect surveillance of oncogenic risk in populations. Conclusions: The role of non-occupational environmental exposure to some heavy metals in daily life is among the more significant oncogenic risk factors in exposed populations. The statistically significant associations between environmental exposure to such heavy metals and frequency of neoplasia in exposed populations become obvious when demonstrated on maps using the GIS system. Environmental surveillance of heavy metals pollution using GIS should be identified as an important element of surveillance, early detection, and control of neoplastic risks in populations, at the level of a single locality, but even on a wider geographical scale.


    Infertility implies inability to conceive after at least one year of unprotected intercourse [1]. About 20% of infertility is explained by male factors. Moreover, in 30–40% of other cases of infertility, both male and female factors are involved [2]. Smoking can adversely affect sperm parameters. As shown in a vast body of research, smokers have a lower volume of semen and lower sperm count and motion than non-smokers [3]. Currently, there are more than 10 million smokers in Iran [4]. Smoking can increase free radicals and decrease antioxidants [5]. Naturally, there is a balance between free radicals and antioxidants inside human body. However, if for any reason such as environmental contamination (cigarette consumption), free radicals are more profusely produced or the antioxidant defense system is weakened, it can lead to oxidative stress [6]. Thus, smoking can raise the number of free radicals inside body and hence can induce oxidative stress [7]. A myriad of research has shown that the ROS level of seminal fluid can be lowered using oral antioxidants that help to amplify the clearing capacity of free radicals [8]. In their research, Lingappa et al. (2015) explored the effect of smoking on sperm parameters in B.G. Nagara medical institution. Their research findings revealed that smoking affected sperm motion and count negatively. Yet, this negative effect on the former exceeded that of the latter. The results also showed that the vital parameters of semen such as sperm motion and motility were reduced [9]. Prescription of L-Carnitine, Arginine, zinc, selenium, vitamin B12 as well as many antioxidants such as vitamins C, E and glutathione and Q10 helped to improve sperm parameters [10]. In some research by Kodama et al., oral prescription of vitamin C plus vitamin E and glutathione for 2 months proved to increase the count of sperms [11]. Moreover, several studies showed the positive effects of selenium in a proper dosage on the quality of sperm specially sperm count, motion and morphology. Among these studies was the work of research by Macpherson et al. who reported that selenium could positively affect sperm motion in infertile men [12]. Considering the great number of infertile male smokers in community and due to the very limited number of quantitative studies concerning the effect of oral vitamins on semen parameters in infertile male smokers, the present research intended to explore the effect of oral vitamin complements on changing fertility indices in male smokers of Bandar Abbas.

    The present research was a single-blinded clinical trial. All procedure in this study were approved by the Ethics Committee of Hormozgan University of Medical Sciences (IR.HUMS.REC.1398.061) and Iranian Registry of Clinical Trial (registration no: IRCT20190617043914N1). The research population comprised infertile oligospermic and asthenospermic men visiting Payambar A'zam public sub-specialized infertility clinic in Bandar Abbas. In the first phase, in advance to the study, all participants were asked for informed consent to take part in the research. This was done through an interview. All patients had at least one year experience of inability to conceive. The inclusion criteria were asthenospermia/oligospermia, cigarette smoking (according to WHO, consuming 100 cigarettes a year during one's life would act as the criterion) [13], more than a year of infertility, no history of surgery in genitals or pelvis such as vasectomy, varicocele, hernia, etc., no alcohol consumption or drug addiction, no chronic physical/mental disease including cardiac, renal, immunological, cancer, hepatic and AIDS, no consumption of vitamin complements within the past 2 months, no exposure to radiation during work or routine activities. The main exclusion criteria were azoospermia or reports of sexual problems, use of any unscheduled vitamin complement, ICSI candidate for intense spermographic disorders and unwillingness to take part in the research. The initial inclusion information was obtained via a checklist developed by the researcher. In the second phase, the subjects were visited by an urologist. Their seminal fluid test results were examined. Eventually, 50 asthenospermic and oligospermic subjects were selected. They were informed of the need for a seminal fluid test so as not to have an intercourse for 3–4 days. Upon arrival at the lab, a sample was taken through masturbation. Once taken, the sample was stored in an incubator at 37 degrees for 20 minutes to liquefy. Computerized seminal fluid analysis was done in vitro based on WHO standards. For all subjects, color, volume, viscosity, count, motion, morphology and pH were analyzed.

    Upon receiving the test results, each patient visited the same physician and followed the prescribed medical diet in proper dosage and time. This procedure took 3 months. The prescribed medicine contained 30 mg of Q10, 8 mg of zinc, 100 mg of vitamin C, 12 mg of vitamin E, 400 µg of folic acid once a day and 200 mg of selenium every other day after lunch. To control the complements and prevent attrition, every two weeks the subjects were contacted through phone calls. At the end of the research, the remaining number of tablets or capsules was counted to see the extent to which the subjects followed the prescribed medical diet. Participants who had not taken more than 10% of the tablets were eliminated from the study. At the end of the third month, all subjects were informed to come for a seminal fluid test after 3 days of refraining from sexual intercourse. They referred to the same lab as for the first test. The same full list of information obtained for the first test was again obtained for this second test. For data analysis, the data entered SPSS.23. Mean and standard deviation were used to describe quantitative data. Frequency and percentage were used to describe qualitative data. To test the research hypotheses, a test of normality (Shapiro-Wilk) was run as well as a test of variance equality (Levene's test). One-way ANOVA was run to compare quantitative data. Chi-squared test was used to compare qualitative data. Paired-sample T-test was used to compare the means cores of quantitative data before and after the intervention. The significance level was set at p ≤ 0.05.

    The mean age of the patients was 32.24 ± 6.87 years; the length of their infertility was 4.16 ± 2.82 years. Sperm parameters were divided in two groups of qualitative and quantitative. Each had a certain statistical analysis. The mean scores for sperm parameters can be observed before the intervention and after 3 months of receiving antioxidant vitamins in Table 1.

    Quantitative parameters after intervention:

    To compare the mean scores of sperm parameters before and after intervention, paired-sample T-test was run, as can be observed in Table 1.

    Comparison of mean sperm parameters before and after intervention showed that the mean volume of sperm changed from 3.48 ± 1.44 to 3.71 ± 1.42; sperm motion changed from 27.22 ± 13.69 to 31.85 ± 5.82; sperm morphology changed from 23.22 ± 23.28 to 33.60 ± 20.01; sperm count turned from 21.76 ± 23.02 to 23.22 ± 23.28; progressive motility was increased from 9.82 ± 9.10 to 11.57 ± 10.18.

    All sperm parameters including total motility, morphology, count and progressive motility were significantly increased after the intervention (p ≥ 0.005). Yet, pH (in the parametric test) was decreased but not to a statistically significant extent (p = 0.07).

    Table 1.  Comparison of mean scores for sperm parameters before and after intervention.
    Sperm Parameter Group F. Mean Sd T-Value P-Value
    Volume Pre-test 50 3.48 1.44 2.20 0.032
    Post-test 50 3.71 1.42
    Ph Pre-test 50 7.31 0.29 1.85 0.070
    Post-test 50 7.27 0.18
    Total Motility Pre-test 50 27.22 13.69 3.96 0.001
    Post-test 50 31.85 15.82
    Morphology Pre-test 50 23.22 23.28 3.14 0.003
    Post-test 50 33.60 20.01
    Count Pre-test 50 21.76 23.02 4.01 0.001
    Post-test 50 23.22 23.28
    Motility Pre-test 50 9.82 9.10 5.87 0.001
    Post-test 50 11.57 10.18

     | Show Table
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    Qualitative parameters after intervention:

    To better compare the effectiveness of therapeutic methods in sperm pH, the pH of patients' sperm was classified as either normal or abnormal. pH at or above 7.2 was taken as normal and below that degree was taken as abnormal.

    To compare the quality of pH before and after the intervention, McNamara's test was run. The results showed that from among 14 subjects with abnormal pH = 5 (10%) (p = 0.001) had a return to a normal extent of pH. This change was statistically significant and showed a significant improvement.

    In terms of sperm concentration, the subjects were divided in 3 groups (below normal, normal and above normal). The test results revealed that 2 of 16 subjects had an above-normal sperm concentration (12.2%) (p = 0.001). Their sperm concentration returned to a normal state which was statistically significant (p = 0.001).

    Comparison of patients' sperm parameters before and after the interventions showed that consuming vitamin complements (30 mg of Q10, 8 mg of zinc, 100 mg of vitamin C, 12 mg of vitamin E, 400 µg of folic acid once a day and 200 mg of selenium every other day) can significantly increase sperm volume, total motility, morphology, count and progressive motility. Moreover, sperm pH and concentration were improved. The present research was a single-blinded clinical trial on both semen parameters and the effect of antioxidant vitamin. Thus, there is no other similar research to directly compare the results with. Yet, other studies looked into more details and discussed them accordingly. The present findings are comparable with the research by Zareba et al. (2013). Yet, they were not consistent with these findings. Zareba et al. found no statistically significant correlation between the vitamin-rich (A,E) diet and all sperm parameters [14]. Moreover, Kacem et al. (2014) observed no significant difference in sperm parameters after receiving antioxidant complements [15]. This may be due to the fact that in the study of Kassem et al., Patients in addition to oral antioxidant use also had assisted reproductive methods such as IVF during the study, while in the present study patients who used assisted reproductive methods. Are excluded. However, in the research conducted by Islamian et al. (2012), the combined effect of vitamin D complement and docosahexaenoic acid was investigated on oxidative stress indices of semen in asthenospermic men. The results revealed that the combined treatment with fatty acid complement, docosahexaenoic acid and vitamin E in asthenospermic men managed to reduce oxidative stress in seminal plasma. Consequently, the oral application of antioxidants can potentially be a way to stop oxidative damage to sperm in infertile men [16]. In some other research, Keshavars et al. (2011) explored the antioxidant effects of vitamins C and E on the oxidative stress induced by sulfasalazine in rats' testicles. Sulfasalazine showed to increase oxidative stress and thus disrupted spermatogenesis. Vitamins E, C showed to lower oxidative stress and thus prevented the harmful effects of sulfasalazine on spermatogenesis [17]. Moreover, several studies attested to the positive effect of an appropriate dose of selenium on the quality of sperm viability, motility and morphology. Among them was the work of research by Macpherson et al. who reported that selenium improved sperm total motility in infertile men [12]. In some other research, the effect of Q10 was explored in male infertility. One such study was conducted by Lewin et al. who showed that the oral application of Q10 (60 mg/kg) could improve fertility in the ICSI of normospermic subjects [18]. In their study, Hassanali et al. (2007) showed that zinc in the plasma of seminal fluid was positively correlated with sperm count and negatively correlated with sperm total motility in normospermic and oligospermic men but correlated with sperm morphology [19]. Other works of research can be observed in Table 2.

    Table 2.  Results of consuming antioxidant consumption on semen parameters in the related literature.
    Author(s) Sample size Target population Antioxidant Consumption Length of consumption Result(s)
    Elsheikh et al. (2015) [20] 90 Oligo-asthenospermia Vitamin E (400 mg) + clomifene citrate (25 mg) Daily 6 months Increased sperm concentration (p = 0.001)
    Safarinezhad (2009) [21] 212 Oligozoospermia Asthenospermia Q10 (300 mg) Daily 26 weeks Increased sperm concentration and total motility (p = 0.001)
    Nouri et al. (2007) [22] 60 Asthenozoospermia Vitamin E (400 mg) + vitamin C (1000 mg) Daily 2 months Except for increased sperm total motility (p ≤ 0.05), no Significant effect on other parameters
    Keskes-Ammar et al. (2003) [23] 72 Infertile male Vitamin E (400 mg)+selenium (225 mg) Daily 3 months Increased sperm total motility and concentration (p ≤ 0.05) and no significant effect on semen morphology (p ≥ 0.05)
    Kodama et al. (1997) [11] 14 Infertile male Vitamin E (20 mg) + vitamin C (200 mg) + glutathione (400 mg) Daily 2 months Increased sperm count (p ≤ 0.05)
    Suleiman et al. (1996) [24] 52 asthenozoospermia Infused vitamin E (100 mg) 3 times a day 6 months Increased motility (p ≤0.05)

     | Show Table
    DownLoad: CSV

    Consuming 30 mg of Q10, 8 mg of zinc, 100 mg of vitamin C, 12 mg of vitamin E, 400 µg of folic acid once a day and 200 mg of selenium every other day showed to positively affect qualitative parameters (concentration and pH) as well as quantitative parameters (volume, total motility, morphology, count and progressive motility). Yet, there is a need for further research with more subjects and research at molecular level.

    [1] European Environment and Health Strategies (EHAP) 2004-2010 Programme. http://ec.europa.eu/health/healthy_environments/policy/health_environment/actionplan_en.htm
    [2] Fasinu P, Orisakwe OE: Heavy metal pollution in sub-Saharan Africa and possible implications in cancer epidemiology. Asian Pac J Cancer Prev. 2013; 14(6):3393-402.
    [3] Tabrez S, Priyadarshini M, Priyamvada S, Khan MS, Na A, Zaidi SK: Gene-environment interactions in heavy metal and pesticide carcinogenesis. Mutat Res Genet Toxicol Environ Mutagen. 2014 Jan 15; 760:1-9. doi: 10.1016/j.mrgentox.2013.11.002. Epub 2013 Dec 3.
    [4] Åkesson A, Barregard L, Bergdahl IA, Nordberg GF, Nordberg M, Skerfving S: Non-renal effects and the risk assessment of environmental cadmium exposure. Environ Health Perspect. 2014 May; 122(5):431-8. doi: 10.1289/ehp.1307110. Epub 2014 Feb 25.
    [5] Adams SV, Quraishi SM, Shafer MM, Passarelli MN, Freney EP, Chlebowski RT, Luo J, Meliker JR, Mu L, Neuhouser ML, Newcomb PA: Dietary cadmium exposure and risk of breast, endometrial, and ovarian cancer in the Women's Health Initiative. Environ Health Perspect. 2014 Jun; 122(6):594-600. doi: 10.1289/ehp.1307054. Epub 2014 Mar 14.
    [6] Hartwig A: Cadmium and cancer. Met Ions Life Sci. 2013; 11:491-507. doi: 10.1007/978-94-007-5179-8_15. Review.
    [7] Nagata C, Nagao Y, Nakamura K, Wada K, Tamai Y, Tsuji M, Yamamoto S, Kashiki Y.: Cadmium exposure and the risk of breast cancer in Japanese women. Breast Cancer Res Treat. 2013 Feb; 138(1):235-9. doi: 10.1007/s10549-013-2414-4.
    [8] Kossowska B, Dudka I, Gancarz R, Antonowicz-Juchniewicz J.: Application of classic epidemiological studies and proteomics in research of occupational and environmental exposure to lead, cadmium and arsenic. Int J Hyg Environ Health. 2013 Jan; 216(1):1-7. doi: 10.1016/j.ijheh.2012.03.002. Epub 2012 Apr 8. Review.
    [9] Bacquart T, Frisbie S, Mitchell E, Grigg L, Cole C, Small C, Sarkar B: Multiple inorganic toxic substances contaminating the groundwater of Myingyan Township, Myanmar: arsenic, manganese, fluoride, iron, and uranium. Sci Total Environ. 2015 Jun 1; 517:232-45. doi: 10.1016/j.scitotenv.2015.02.038. Epub 2015 Mar 5.
    [10] Liu X, Song Q, Tang Y, Li W, Xu J, Wu J, Wang F, Brookes PC: Human health risk assessment of heavy metals in soil-vegetable system: a multi-medium analysis. Sci Total Environ. 2013 Oct 1; 463-464:530-40. doi: 10.1016/j.scitotenv.2013.06.064. Epub 2013 Jul 5.
    [11] Verougstraete V,Lison D,Hotz P: Cadmium, lung and prostate cancer: a systematic review of recent epidemiological data. J Toxicol Environ Health B Crit Rev.2003 May-Jun; 6(3):227-55.
    [12] Yuan X, Wang J, Shang Y, Sun B: Health risk assessment of cadmium via dietary intake by adults in China. J Sci Food Agric. 2014 Jan 30; 94(2):373-80.
    [13] Saleem M, Iqbal J, Shah MH: Non-carcinogenic and carcinogenic health risk assessment of selected metals in soil around a natural water reservoir, Pakistan. Ecotoxicol Environ Saf. 2014 Oct; 108:42-51. doi: 10.1016/j.ecoenv.2014.06.017.
    [14] Xingmei L,, Jianjun W, Jianming X, Characterizing the risk assessment of heavy metals and sampling uncertainty analysis in paddy field by geostatistics and GIS, Environmental Pollution, Volume 141, Issue 2, May 2006, Pages 257-264, (http://www.sciencedirect.com/science/article/pii/S0269749105004549)
    [15] Celine Siu-lan Lee, Xiangdong Li, Wenzhong Shi, Sharon Ching-nga Cheung, Iain Thornton: Metal contamination in urban, suburban, and country park soils of Hong Kong: A study based on GIS and multivariate statistics. Environmental Pollution Volume 141, Issue 2, May 2006, Pages 257–264.
    [16] Chaosheng Zhang: Using multivariate analyses and GIS to identify pollutants and their spatial patterns in urban soils in Galway, Ireland. Environmental Pollution Volume 142, Issue 3, August 2006, Pages 501–511.
    [17] A Facchinelli, E Sacchi, , L Mallen: Multivariate statistical and GIS-based approach to identify heavy metal sources in soils. Environmental Pollution Volume 114, Issue 3, October 2001, Pages 313–324.
    [18] Colak EH, Yomralioglu T, Nisanci R, Yildirim V, Duran C.: Geostatistical analysis of the relationship between heavy metals in drinking water and cancer incidence in residential areas in the Black Sea region of Turkey. J Environ Health. 2015 Jan-Feb; 77(6):86-93.
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