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Rashidi, et al. Soil lead contamination and cancer provinceʹs soils. Pb is up taken by the plants from nant diseases were plotted and compared.[5] contaminated land, thus agricultural products are the most important way to enter this element in the food RESULTS chain. Pb is not biodegradable, does not undergo dis‐ sociation, and cannot be metabolized in human body. Overall 10,142 medical records of patients with docu‐ Therefore, after entering the body, Pb will be deposited mented pathology report of cancer in 2007 to 2009 were and accumulated in blood, skin, organs, and tissues recruited from the Cancer Registry data. The ten most such as fat, muscles, bones, and joints.[4] prevalent cancers are presented in Table1.

This study aimed to map Pb distribution and the Spatial distribution of Pb in 2007‐2009 is depicted in spatial distribution of the ten most common types of Figure1. It shows that Pb was more abundant in south, cancers in the province. west, center, north, and east of the province. Mapping the distribution of malignant diseases is presented in METHODS Figures 2 to 6. Skin cancer was more prevalent in cities of Isfahan, Najaf Abad, , Naeen, , and The ten most common cancers in Isfahan were (Figure 2). The rate of skin cancer was corre‐ determined by using data recorded from 2007 to 2009 lated with Pb distribution in the province, i.e. it was by the Isfahan Cancer Registry Program of the Isfahan lower in areas away from Pb‐contaminated regions. Provincial Health Center. We obtained the distribution map of Pb in the province of Isfahan during 2007 to As shown in Figure3, the prevalence of breast cancer 2009 from the Mineral Exploration Organization, and was also directly related with the soil Pb concentration. the information on soil Pb concentration from the The cities of Isfahan, Najaf Abad, Kashan, Borkhar, Isfahan Agricultural Jihad Organization. The Pb con‐ , Naeen, Ardestan, and Natanz had the high‐ centration was documented in three fields of agricul‐ est prevalence of breast cancer (Figure3). The spatial tural, non‐agricultural, and urban and industrial land. distribution of hematological malignancies was consis‐ tent with the distribution of soil Pb throughout the The geographic mapping of cancers and soil Pb was province (Figure4). then incorporated using Geographic Information Sys‐ tem (GIS) software. After producing the spatial distri‐ Mapping of bladder and prostate cancers were not as‐ bution model, the spatial distribution maps of malig sociated with soil Pb distribution (Figures 5 and 6).

Table 1. Most prevalent cancers in the province of Isfahan during 2007-2009

Skin Breast Hematologic Bladder Stomach Lymphomas Thyroid Unknown Prostate Colon cancer cancer cancers cancer cancer cancer cancers cancer cancer 2729 1759 1026 943 939 783 716 686 561 541 Values are expressed as number of infected people.

Figure 1. Soil lead distribution map in the province of Isfahan, Iran (Values are presented in Km.)

| April 2012 | Journal of Research in Medical Sciences 349 www.mui.ac.ir Rashidi, et al. Soil lead contamination and cancer

Figure 2. Spatial distribution of skin cancer in the province of Isfahan, Iran (Values are expressed as number of persons.)

Figure 3. Spatial distribution of breast cancer in the province of Isfahan, Iran (Values are expressed as number of persons.)

350 Journal of Research in Medical Sciences | April 2012 | www.mui.ac.ir Rashidi, et al. Soil lead contamination and cancer

Figure 4. Spatial distribution of hematological malignancies in the province of Isfahan, Iran (Values are expressed as number of persons.)

Figure 5. Spatial distribution of bladder cancer in the province of Isfahan, Iran (Values are expressed as number of persons.)

| April 2012 | Journal of Research in Medical Sciences 351 www.mui.ac.ir Rashidi, et al. Soil lead contamination and cancer

Figure 6. Spatial distribution of prostate cancer in the province of Isfahan, Iran (Values are expressed as number of persons.)

DISCUSION sheathing, ammunition, glass, ceramics, Pb pipes, paints, alloys, connections, and joints in roofs used for Plotting the spatial distribution of the most common protection against rain. The larger Pb particles drop to types of malignant diseases and soil Pb concentration the ground straightaway and will pollute soils or sur‐ showed significant associations between mapping for face waters, whereas the smaller particles will be skin, breast, and hematological malignancies and Pb transported long distances through air and may re‐ distribution in the province of Isfahan. This finding main in the atmosphere. Part of Pb will fall back on may suggest that soil contamination by Pb, and possi‐ ground by raining. This Pb‐cycle caused by human bly other industrial metals, may contribute in the inci‐ production is more extended than the natural Pb‐ dence of cancers. We should acknowledge that in addi‐ cycle.[6,7] tion to the possible association of soil Pb with malig‐ nancies, the higher prevalence of diagnosed cancers Although Western lifestyle, obesity, smoking, and epi‐ might have been a result of better medical facilities and demiologic transition have crucial roles in the devel‐ health centers in larger cities of the province. However, opment of non‐communicable diseases, including can‐ our data comprised the records from the whole prov‐ cers, they cannot solely explain the worldwide rapid ince including smaller cities for three years, and earlier increase in the incidence of cancers. Environmental diagnosis of malignancies in larger cities would not pollution, including soil contamination by toxic metals affect our findings. during industrialization may be an important contri‐ buting factor.[8‐10] In 1980, Barrett depicted the spatial Pb pollution has become a worldwide issue. Although distribution as the possible etiology of disease, and Pb naturally exists in the environment, most Pb con‐ proposed the importance of medical geography on centrations found in the environment are accumulated human health. He suggested for the first time that a from human activities. The industrial pollutants, ferti‐ geographic area represents the complex physical, bio‐ lizers, and other agricultural items are the main logical, and cultural processes. By analyzing the ele‐ sources of Pb added to the environment by humans. Pb ments and patterns, it is possible to determine and distribution in the areas where the population and track the spatial distribution of various diseases.[11] human activities are higher is more prominent. The main reason can be contamination by industrial pollu‐ A large body of evidence supports the health hazards tion, Pb‐acid batteries, electronic components, cable of environmental Pb exposure.[12‐17] It is estimated that 352 Journal of Research in Medical Sciences | April 2012 | www.mui.ac.ir Rashidi, et al. Soil lead contamination and cancer reducing the concentrations of environmental Pb can have to consider effective measures to reduce the pro‐ significantly decrease the standardized death rate.[18] duction of and exposures to Pb and other industrial The carcinogenic effects of Pb have been documented metals that are currently contaminating the environ‐ in some previous studies. A study in Taiwan revealed ment. that living in high Pb‐polluted areas can result in an increased incidence rate of brain cancer.[19] An ecologic study conducted in 2000‐2007 among Chinese popula‐ REFERENCES tion living in nine agricultural villages with high envi‐ ronmental pollution showed significant associations 1. Azizi F. Epidemiology and Control of Common Diseases in Iran. : Tehran University Press; 2001. between exposure to multiple heavy metals, including 2. Anand P, Kunnumakkara AB, Sundaram C, Harikumar KB, Pb, and cancer mortality.[20] Our findings on the proba‐ Tharakan ST, Lai OS, et al. Cancer is a preventable disease that ble association of Pb exposure with breast cancer are requires major lifestyle changes. Pharm Res 2008; 25(9): 2097- 116. consistent with some previous studies.[21‐23] In addition 3. Yavar B, Pour-Ahmad A. Medical geography of esophageal to ecological studies, such association has also been cancer in Iran. 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