Bladder Cancer and Water Disinfection By-product Exposures through Multiple Routes: A Population-Based Case–Control Study (New England, USA)

Freeman, Laura E. Beane; Cantor, Kenneth P.; Baris, Dalsu; Nuckols, John R.; Johnson, Alison; Colt, Joanne S.; Schwenn, Molly; Ward, Mary H.; Lubin, Jay H.; Waddell, Richard; Hosain, G. M. Monawar; Paulu, Chris; McCoy, Richard; Moore, Lee E.; Huang, An-Tsun; Rothman, Nat; Karagas, Margaret R.; Silverman, Debra T.

doi:10.1289/ehp89

Cited by 56 publications

(48 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We used pooled data for 3,481 cases and 5,977 controls from 7 case-control studies included in a meta-analysis by Costet et al (2011) to derive the continuous exposure-response function that was the basis of our country-specific ORs for bladder cancer in association with country-specific mean THM estimates. Although this is the most comprehensive pooled analysis currently available, it is limited to case-control studies and does not include a recent U.S. study of 1,213 bladder cancer cases and 1,418 controls (Beane Freeman et al 2017).…”

Section: Environmental Health Perspectivesmentioning

confidence: 99%

“…Our analyses are based on men and women combined. While most of the case-control studies included in the pooled analysis report a null or inverse association among women, there are also case-control studies showing higher risks in women than men (Beane Freeman et al 2017). Future studies may want to consider comparing estimates based on sex-specific exposure-response functions to estimates for men and women combined.…”

Section: Countrymentioning

confidence: 99%

See 1 more Smart Citation

Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union

Evlampidou

Font-Ribera

Rojas-Rueda

et al. 2020

Environ Health Perspect

120

View full text Add to dashboard Cite

BACKGROUND: Trihalomethanes (THMs) are widespread disinfection by-products (DBPs) in drinking water, and long-term exposure has been consistently associated with increased bladder cancer risk. OBJECTIVE: We assessed THM levels in drinking water in the European Union as a marker of DBP exposure and estimated the attributable burden of bladder cancer. METHODS: We collected recent annual mean THM levels in municipal drinking water in 28 European countries (EU28) from routine monitoring records. We estimated a linear exposure-response function for average residential THM levels and bladder cancer by pooling data from studies included in the largest international pooled analysis published to date in order to estimate odds ratios (ORs) for bladder cancer associated with the mean THM level in each country (relative to no exposure), population-attributable fraction (PAF), and number of attributable bladder cancer cases in different scenarios using incidence rates and population from the Global Burden of Disease study of 2016. RESULTS: We obtained 2005-2018 THM data from EU26, covering 75% of the population. Data coverage and accuracy were heterogeneous among countries. The estimated population-weighted mean THM level was 11:7 lg=L [standard deviation (SD) of 11.2]. The estimated bladder cancer PAF was 4.9% [95% confidence interval (CI): 2.5, 7.1] overall (range: 0-23%), accounting for 6,561 (95% CI: 3,389, 9,537) bladder cancer cases per year. Denmark and the Netherlands had the lowest PAF (0.0% each), while Cyprus (23.2%), Malta (17.9%), and Ireland (17.2%) had the highest among EU26. In the scenario where no country would exceed the current EU mean, 2,868 (95% CI: 1,522, 4,060; 43%) annual attributable bladder cancer cases could potentially be avoided. DISCUSSION: Efforts have been made to reduce THM levels in the European Union. However, assuming a causal association, current levels in certain countries still could lead to a considerable burden of bladder cancer that could potentially be avoided by optimizing water treatment, disinfection, and distribution practices, among other possible measures.

show abstract

Section: Environmental Health Perspectivesmentioning

confidence: 99%

Section: Countrymentioning

confidence: 99%

Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union

Evlampidou

Font-Ribera

Rojas-Rueda

et al. 2020

Environ Health Perspect

120

View full text Add to dashboard Cite

show abstract

“…It has been suggested that the byproducts of water disinfection such as chlorinated and brominated trihalomethanes (THMs) may increase the risk of bladder cancer. This risk was evaluated in a recent population-based case-control study from the National Cancer Institute in the United States [33]. This showed a weak association between drinking water with high levels of THMs and bladder cancer (OR 1.53, 95%CI: 1.01-2.32).…”

Section: Environmentmentioning

confidence: 99%

Prevention of bladder cancer incidence and recurrence

Fankhauser

Mostafid

2018

Current Opinion in Urology

View full text Add to dashboard Cite

show abstract

“…However, epidemiological research has reported associations between adverse health effects and the presence of disinfection byproducts in tap water at concentrations that generally meet applicable national drinking water standards [3]. Multiple studies have reported an increased risk of bladder cancer in association with exposure to drinking water disinfection byproducts [4][5][6], and the risk of other cancers has been suggested [7,8]. Birth defects [9] and miscarriages [10] have also been linked to disinfection byproducts.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Cumulative Cancer Risk Associated with Disinfection Byproducts in United States Drinking Water

Evans

Campbell

Naidenko

2020

IJERPH

View full text Add to dashboard Cite

Hundreds of different disinfection byproducts form in drinking water following necessary treatment with chlorine and other disinfectants, and many of those byproducts can damage DNA and increase the risk of cancer. This study offers the first side-by-side comparison of cancer risk assessments based on toxicological and epidemiological studies of disinfection byproducts using a comprehensive contaminant occurrence dataset for haloacetic acids and trihalomethanes, two groups of disinfection byproducts that are regulated in drinking water. We also provide the first analysis of a new occurrence dataset for unregulated haloacetic acids that became available from the latest, fourth round of the U.S. EPA-mandated unregulated contaminant monitoring program (UCMR4). A toxicological assessment indicated that haloacetic acids, and in particular brominated haloacetic acids, are more carcinogenic and are associated with a greater number of attributable cancer cases than trihalomethanes. Based on the toxicological analysis, cumulative lifetime cancer risk due to exposure to trihalomethanes and haloacetic acids for community water systems monitored under UCMR4, estimated with standard default parameters for body weight and water intake, corresponds to 7.0 × 10−5 (3.5 × 10−5–1.3 × 10−4). The same analysis conducted with age sensitivity factors to account for elevated risk in infants and children yielded a cumulative risk estimate of 2.9 × 10−4 (1.7 × 10−4–6.2 × 10−4). Epidemiological data suggest that lifetime cancer risk from disinfection byproducts for the U.S. population served by community water systems is approximately 3.0 × 10−3 (2.1 × 10−4–5.7 × 10−3), or a lifetime cancer risk of three cases per thousand people. Overall, this analysis highlights the value of using human data in health risk assessments to the greatest extent possible.

show abstract

Bladder Cancer and Water Disinfection By-product Exposures through Multiple Routes: A Population-Based Case–Control Study (New England, USA)

Cited by 56 publications

References 26 publications

Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union

Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union

Prevention of bladder cancer incidence and recurrence

Analysis of Cumulative Cancer Risk Associated with Disinfection Byproducts in United States Drinking Water

Contact Info

Product

Resources

About