Chlorination, chlorination by-products, and cancer: a meta-analysis.

Morris, Robin; Audet, Anne-Marie J.; Angelillo, Italo Francesco; Chalmers, Thomas C.; Mosteller, Frederick

doi:10.2105/ajph.82.7.955

Cited by 494 publications

(219 citation statements)

References 22 publications

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“…A meta-analysis of seven studies of bladder cancer risk from consumption of chlorinated water resulted in a RR of 1.21 (95% CI 1.09-1.34) (Morris et al, 1992). This estimate was not modified after adjusting for smoking.…”

Section: Cancer Risk From Water Chlorination By-productsmentioning

confidence: 96%

Epidemiology of environmental and occupational cancer

Boffetta

2004

Oncogene

122

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Environmental carcinogens, in a strict sense, include outdoor and indoor air pollutants, as well as soil and drinking water contaminants. An increased risk of mesothelioma has consistently been detected among individuals experiencing residential exposure to asbestos, while results for lung cancer are less consistent. Several good-quality studies have investigated lung cancer risk from outdoor air pollution based on measurement of specific agents. Their results tend to show an increased risk in the categories at highest exposure, with relative risks in the range 1.5. A causal association has been established between exposure to environmental tobacco smoke and lung cancer, with a relative risk in the order of 1.2. Radon is another carcinogen present in indoor air, with a relative risk in the order of 1.06 for exposure at 100 Bq/m 3 . In several Asian populations, an increased risk of lung cancer results among women from indoor pollution from cooking and heating. There is strong evidence of an increased risk of bladder, skin and lung cancers following consumption of water with high arsenic contamination; results for other drinking water contaminants, including chlorination by-products, are inconclusive. A total of 29 occupational agents are established human carcinogens, and another 30 agents are suspected carcinogens. In addition, at least 12 exposure circumstances entail exposure to carcinogens. Exposure is still widespread for many important occupational carcinogens, such as asbestos, coal tar, arsenic and silica, in particular in developing countries. Although estimates of the global burden of occupational and environmental cancer result in figures in the order of 2% and less than 1%, respectively, these cancers concentrate in subgroups of the population; furthermore, exposure is involuntary and can, to a large extent, be avoided.

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Section: Cancer Risk From Water Chlorination By-productsmentioning

confidence: 96%

Epidemiology of environmental and occupational cancer

Boffetta

2004

Oncogene

122

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“…The increased concentration of Cl -in some water tap samples could be the result of the disinfection process utilizing chlorination. Another concern associated with chlorination is the formation of disinfection byproducts (DBPs) such as trihalomethanes (THMs), which have been shown to induce human bladder and rectal cancers (Morris et al, 1992;Villanueva et al, 2001). The results for bromide (Br -) show a minimum concentration of 0.15 mg/l and a maximum concentration of 3.46 mg/l, with an average concentration of 0.57 mg/l in all of the tap water samples examined.…”

Section: Major Anionsmentioning

confidence: 99%

Physical and chemical characteristics of drinking water quality in Kuwait: tap vs. bottled water

2015

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“…The toxicologic evidence indicates that the liver and kidney are the primary target organs for DBPs (29). The epidemiologic data suggests that trihalomethanes may be associated with cancer of the bladder and rectum (30). Toxicologic research typically focuses on the impact of individual compounds, whereas epidemiologic studies evaluate mixtures of compounds present in drinking water.…”

mentioning

confidence: 99%

3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) and mutagenic activity in Massachusetts drinking water.

Wright

Schwartz

Vartiainen

et al. 2002

Environ Health Perspect

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There is limited information on the prevalence of the potent mutagen 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) in U.S. water supplies. We measured MX concentrations and mutagenic activity in tap water samples from 36 surface water systems throughout Massachusetts. We found MX levels much higher (up to 80 ng/L) than previously reported in the United States. We also evaluated the role of water treatment on mutagenic activity and disinfection by-product formation. After adjusting for other covariates, chloramination and filtration were the most important treatment options for reducing mutagenic activity and disinfection by-product formation. Multiple chlorine application (before and after filtration) was associated with increased mutagenicity. Chlorine dose, pH, and total organic carbon were also associated with mutagenicity, MX, and total trihalomethane (TTHM) concentration. Seasonal variation was evident for MX and mutagenic activity, with higher levels occurring in the spring compared to the fall. In contrast, TTHM concentrations were greater in the fall.

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Chlorination, chlorination by-products, and cancer: a meta-analysis.

Cited by 494 publications

References 22 publications

Epidemiology of environmental and occupational cancer

Epidemiology of environmental and occupational cancer

Physical and chemical characteristics of drinking water quality in Kuwait: tap vs. bottled water

3-Chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX) and mutagenic activity in Massachusetts drinking water.

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