Occup Environ Med 69:153-156 doi:10.1136/oemed-2011-100111
  • Short report
  • Original article

Cadmium exposure and cancer mortality in the Third National Health and Nutrition Examination Survey cohort

  1. Polly A Newcomb1,2
  1. 1Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
  2. 2Department of Epidemiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Scott V Adams, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA 98109, USA; sadams{at}
  1. Contributors SVA contributed to the study concept, and analysis and interpretation of data, and was the lead author. MNP contributed to data analysis and manuscript revision. PAN contributed to the study concept, manuscript revision and interpretation of data. SVA is the guarantor.

  • Accepted 6 October 2011
  • Published Online First 7 November 2011


Objective This study examined prospective data from the Third National Health and Nutrition Examination Survey (NHANES III) cohort to investigate the relationship between cadmium exposure and cancer mortality, and the specific cancers associated with cadmium exposure, in the general population.

Methods Vital status and cause of death through 31 December 2006 were obtained by the National Center for Health Statistics for NHANES III participants. The cadmium concentration of spot urine samples was measured and corrected for urine creatinine (uCd). Weighted Cox proportional hazards regression with age as the time metric was applied to estimate sex-specific adjusted HRs (aHRs) of mortality associated with uCd for all cancers and the cancers responsible for the most deaths in the USA. Estimates were stratified by smoking history and adjusted for education, body mass index and race.

Results uCd was associated with cancer mortality (aHR per twofold higher uCd (95% CI), men: 1.26 (1.07 to 1.48); women: 1.21 (1.04 to 1.42)). In men, mortality from lung cancer, pancreatic cancer and non-Hodgkin lymphoma was associated with uCd; an association with leukaemia mortality was suggested. In women, associations were suggested with mortality due to lung cancer, leukaemia, ovarian and uterine cancer, but evidence was weaker than in men.

Conclusions Cadmium appears to be associated with overall cancer mortality in men and women, but the specific cancers associated differ between men and women, suggesting avenues for future research. Limitations of the study include the possibility of uncontrolled confounding by cigarette smoking or other factors, and the limited number of deaths due to some cancers.


  • Funding This research was not directly funded. SVA was supported in part by NIH National Cancer Institute Cancer Prevention Training Grant R25 CA094880, and an ASPO/ASCO Cancer Prevention Fellowship sponsored by the Prevent Cancer Foundation. Public-use NHANES data were previously collected by the Centers for Disease Control and Prevention.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are publicly available from the original source.