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Abstract
National groundwater surveys suggest that millions of people living in Bangladesh are at risk of ingesting arsenic-contaminated water as the result of a public health initiative that switched the population's drinking water from surface to groundwater by installing shallow tubewells [27]. The concentration of arsenic in these shallow tubewells ranges from non-detectable to upwards of 2,000 ?g/L. It is estimated that approximately 59 % of the tubwells tested exceed the Bangladesh drinking water standard of 50 ?g/L [27]. Inorganic arsenic is a known human carcinogen, and chronic exposure increases the risk of cancers of the skin, bladder, lung, and kidney [10, 39, 41]. Chronic exposure to arsenic is also associated with non-cancer outcomes including bronchitis, cardiovascular disease, adverse reproductive outcomes, and type 2 diabetes [12, 14, 15, 24, 33, 40]. The first dermal signs of arsenic toxicity manifest as melanosis and/or leukomelanosis, keratosis, and hyperkeratosis of the palms and soles [15]. Prospective epidemiologic studies have demonstrated that the risk of arsenic-related skin lesions increases in a dose-dependent manner and that the presence of skin lesions are highly associated with risk of cancer later in life [4, 23].
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