Author response to “Increased risks of upper tract urothelial carcinoma in male and female Chinese herbalists”

摘要

Renal failure and urothelial carcinoma (UC) caused by taking Chinese herbs containing aristolochic acids (AAs) is an important epidemic in Taiwan that has attracted global attention to the hazards of AAs. AAs are derived from ex- tracts of the Aristolochia species and are a common ingredient in many Chinese herbs. Taiwan has the highest incidence of renal failure in the world, and Chinese herbal remedies containing AAs are suspected of being primarily responsible for this increased risk. A longitudinal study using the 1997e2002 Taiwan National Health Insurance reimbursement database found that people taking AA- containing herbal products had an increased risk of UC. 1 By analyzing aristolactameDNA adducts and TP53 muta- tion spectra, Chen et al demonstrated that a high propor- tion of upper tract UC in Taiwan resulted from AA exposure. 2 Herbal remedies containing AA have now been categorized as proven Group 1 human carcinogens. The latency of AA-associated UC ranges between 3 and 5 years depending on the cumulative dose of AA. In Taiwan, most AA-containing herbs have been prohibited since 2003. Although we would watch carefully when the decreasing trend of UC incidence rate occurs, it does not necessarily mean we are able to estimate accurately the latency period of AA-associated UC. Instead, it represents the induction time for prevention to be effective, and we shall be able to estimate the expected number of prevented cases.