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Chronic ingestion of arsenic-contaminated drinking water with inorganic arsenic >10 µg/L...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-ENVIRONMENTAL-ARSENIC-WATER-PREVENTION
TypeRed flag
Statusreviewed 2026-05-18 | pending_clinical_signoff
DiseasesDIS-BCC DIS-NSCLC DIS-UROTHELIAL
SourcesSRC-NCCN-BCELL-2025 SRC-NCCN-NSCLC-2025 SRC-NCCN-SKIN-2025

Red Flag Origin

DefinitionChronic ingestion of arsenic-contaminated drinking water with inorganic arsenic >10 µg/L (WHO Guideline + US EPA MCL since 2006; prior US standard was 50 µg/L). Inorganic arsenic is an IARC Group 1 carcinogen (Monograph 100C, 2012; reaffirms Monograph 84) — established etiologic driver of urothelial / bladder cancer, lung cancer (independent of smoking), and non-melanoma skin cancers (BCC + SCC + Bowen's disease). Endemic high-arsenic groundwater regions: Bangladesh, parts of India + Pakistan, Taiwan, northern Argentina / Chile, US Southwest (private wells), Mongolia, parts of Eastern Europe (including localized Ukrainian rural wells). Dose-response is supralinear at high exposures + uncertain at lower (<100 µg/L) exposures with continued risk demonstrated by cohort studies. Mechanisms: arsenic methylation generates DMA(III) + MMA(III) reactive intermediates; oxidative stress; DNA-repai...
Clinical directioninvestigate
Categoryother

Trigger Logic

{
  "any_of": [
    {
      "finding": "drinking_water_arsenic_gt_10_ug_per_l",
      "value": true
    },
    {
      "finding": "private_well_arsenic_untested",
      "value": true
    },
    {
      "finding": "urinary_inorganic_arsenic_elevated",
      "value": true
    },
    {
      "finding": "endemic_arsenic_region_residence_history",
      "value": true
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for chronic inorganic arsenic exposure via drinking water >10 µg/L (WHO + US EPA MCL). IARC Group 1 carcinogen with established urothelial, lung, and non-melanoma skin cancer etiology. Anchored to DIS-UROTHELIAL per task brief; lung + skin surfaced via relevant_diseases. risk_category=occupational is closest enum match. Engine routes to PreventionPlan recommending water source change / filtration + intensified screening for affected organs. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications