Evaluation of the validity of the US EPA's cancer risk assessment of arsenic for low-level exposures: a likelihood ratio approach

Skin cancers associated with ingesting of arsenic have been documented since the 19th century. A study in the southwestern coastal area of Taiwan where people drank well water containing arsenic is generally recognised as providing the best data available for quantifying the risk, and the US Environmental Protection Agency (EPA) used these data to conduct a risk assessment of arsenic ingestion. However, the lowest exposure category in the Taiwan study included arsenic levels up to 290 µg L^–1, which is nearly six times higher than the current EPA maximum contaminant level (MCL), 50 µg L^–1. Therefore, the EPA risk assessment model extrapolated data on high-level exposures to generate risk estimates for low-level exposures. To evaluate the validity of this model, we conducted a quantitative review of epidemiological studies observing arsenic exposures below 290 µg L^–1. A ratio of the likelihood of the EPA model being inappropriate to that of it being appropriate was calculated for each study population as a measurement of the validity of the EPA model. Although existing human data on low-level exposures are limited, the review suggested that the EPA model is unlikely to be able to predict the risk of skin cancer accurately when the arsenic exposure level is between 170 and 270 µg L^–1.