Dataset Information

Colorectal Cancer and Long-Term Exposure to Trihalomethanes in Drinking Water: A Multicenter Case-Control Study in Spain and Italy.

ABSTRACT: Evidence on the association between colorectal cancer and exposure to disinfection by-products in drinking water is inconsistent.We assessed long-term exposure to trihalomethanes (THMs), the most prevalent group of chlorination by-products, to evaluate the association with colorectal cancer.A multicenter case-control study was conducted in Spain and Italy in 2008-2013. Hospital-based incident cases and population-based (Spain) and hospital-based (Italy) controls were interviewed to ascertain residential histories, type of water consumed in each residence, frequency and duration of showering/bathing, and major recognized risk factors for colorectal cancer. We estimated adjusted odds ratios (OR) for colorectal cancer in association with quartiles of estimated average lifetime THM concentrations in each participant's residential tap water (micrograms/liter; from age 18 to 2 years before the interview) and estimated average lifetime THM ingestion from drinking residential tap water (micrograms/day).We analyzed 2,047 cases and 3,718 controls. Median values (ranges) for average lifetime residential tap water concentrations of total THMs, chloroform, and brominated THMs were 30 (0-174), 17 (0-63), and 9 (0-145) ?g/L, respectively. Total THM concentration in residential tap water was not associated with colorectal cancer (OR = 0.92, 95% CI: 0.66, 1.28 for highest vs. lowest quartile), but chloroform concentrations were inversely associated (OR = 0.31, 95% CI: 0.24, 0.41 for highest vs. lowest quartile). Brominated THM concentrations showed a positive association among men in the highest versus the lowest quartile (OR = 1.43, 95% CI: 0.83, 2.46). Patterns of association were similar for estimated average THM ingestion through residential water consumption.We did not find clear evidence of an association between detailed estimates of lifetime total THM exposure and colorectal cancer in our large case-control study population. Negative associations with chloroform concentrations and ingestion suggest differences among specific THMs, but these findings should be confirmed in other study populations. Citation: Villanueva CM, Gracia-Lavedan E, Bosetti C, Righi E, Molina AJ, Martín V, Boldo E, Aragonés N, Perez-Gomez B, Pollan M, Gomez Acebo I, Altzibar JM, Jiménez Zabala A, Ardanaz E, Peiró R, Tardón A, Chirlaque MD, Tavani A, Polesel J, Serraino D, Pisa F, Castaño-Vinyals G, Espinosa A, Espejo-Herrera N, Palau M, Moreno V, La Vecchia C, Aggazzotti G, Nieuwenhuijsen MJ, Kogevinas M. 2017. Colorectal cancer and long-term exposure to trihalomethanes in drinking water: a multicenter case---control study in Spain and Italy. Environ Health Perspect 125:56-65;?http://dx.doi.org/10.1289/EHP155.

SUBMITTER: Villanueva CM

PROVIDER: S-EPMC5226692 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Colorectal Cancer and Long-Term Exposure to Trihalomethanes in Drinking Water: A Multicenter Case-Control Study in Spain and Italy.

Villanueva Cristina M CM Gracia-Lavedan Esther E Bosetti Cristina C Righi Elena E Molina Antonio José AJ Martín Vicente V Boldo Elena E Aragonés Nuria N Perez-Gomez Beatriz B Pollan Marina M Acebo Ines Gomez IG Altzibar Jone M JM Zabala Ana Jiménez AJ Ardanaz Eva E Peiró Rosana R Tardón Adonina A Chirlaque Maria Dolores MD Tavani Alessandra A Polesel Jerry J Serraino Diego D Pisa Federica F Castaño-Vinyals Gemma G Espinosa Ana A Espejo-Herrera Nadia N Palau Margarita M Moreno Victor V La Vecchia Carlo C Aggazzotti Gabriella G Nieuwenhuijsen Mark J MJ Kogevinas Manolis M

Environmental health perspectives 20160706 1

<h4>Background</h4>Evidence on the association between colorectal cancer and exposure to disinfection by-products in drinking water is inconsistent.<h4>Objectives</h4>We assessed long-term exposure to trihalomethanes (THMs), the most prevalent group of chlorination by-products, to evaluate the association with colorectal cancer.<h4>Methods</h4>A multicenter case-control study was conducted in Spain and Italy in 2008-2013. Hospital-based incident cases and population-based (Spain) and hospital-ba ...[more]

PMID: 27383820

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Project description: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?g/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. https://doi.org/10.1289/EHP4495.

Project description:BACKGROUND:Evidence for a relationship between trihalomethane (THM) or haloacetic acid (HAA) exposure and adverse fetal growth is inconsistent. Disinfection by-products exist as complex mixtures in water supplies, but THMs and HAAs have typically been examined separately. OBJECTIVES:We investigated joint exposure at the individual level to THMs and HAAs in relation to birth weight in the multi-ethnic Born in Bradford birth cohort. METHODS:Pregnant women reported their water consumption and activities via questionnaire. These data were combined with area-level THM and HAA concentrations to estimate integrated uptake of THMs into blood and HAA ingestion, accounting for boiling/filtering. We examined the relationship between THM and HAA exposures and birth weight of up to 7,438 singleton term babies using multiple linear regression, stratified by ethnicity. RESULTS:Among Pakistani-origin infants, mean birth weight was significantly lower in association with the highest versus lowest tertiles of integrated THM uptake (e.g., -53.7 g; 95% CI: -89.9, -17.5 for ? 1.82 vs. < 1.05 ?g/day of total THM) and there were significant trends (p < 0.01) across increasing tertiles, but there were no associations among white British infants. Neither ingestion of HAAs alone or jointly with THMs was associated with birth weight. Estimated THM uptake via showering, bathing, and swimming was significantly associated with lower birth weight in Pakistani-origin infants, when adjusting for THM and HAA ingestion via water consumption. CONCLUSIONS:To our knowledge, this is the largest DBP and fetal growth study to date with individual water use data, and the first to examine individual-level estimates of joint THM-HAA exposure. Our findings demonstrate associations between THM, but not HAA, exposure during pregnancy and reduced birth weight, but suggest this differs by ethnicity. This study suggests that THMs are not acting as a proxy for HAAs, or vice-versa. CITATION:Smith RB, Edwards SC, Best N, Wright J, Nieuwenhuijsen MJ, Toledano MB. 2016. Birth weight, ethnicity, and exposure to trihalomethanes and haloacetic acids in drinking water during pregnancy in the Born in Bradford cohort. Environ Health Perspect 124:681-689; http://dx.doi.org/10.1289/ehp.1409480.

Project description:BackgroundThere is no study conducted on the association between disinfection byproducts (DBPs) in chlorinated drinking water and colorectal cancer (CRC) in Ethiopia. Therefore, this study aimed to determine the relation between chlorine based DBPs in drinking water and CRC in Addis Ababa, Ethiopia.MethodsA facility based matched case control study was conducted involving 224 cases and 448 population controls from June 2020 to May 2021. Cases were defined as histologically confirmed CRC cases. Cases were matched with controls by residence, age, and sex using frequency and individual matching. Geocoding of cases, health facility, and georeferencing of controls were carried out. Data was collected using a pretested structured questionnaire. Pearson Chi square and Fisher's exact tests were employed to assess associations. Stratified analysis was used to detect confounding factors and effect modification. A multivariable conditional logistic regression was used to identify risk factors of CRC.ResultsOf 214 CRC cases, 148 (69.2%) used chlorinated water whereas out of 428 controls 161 (37.6%) used chlorinated water. In the final regression model, drinking chlorinated surface water (adjusted matched odds ratio [adjusted mOR] = 2.6; 95% CI 1.7-4.0), history of swimming (adjusted mOR = 2.4; 95% CI 1.4-4.1), years at the place of current residence (adjusted mOR = 1.5; 95% CI 1.1-2.2), hot tap water use for showering (adjusted mOR; 3.8 = 95% CI 2.5-5.9) were significantly associated with CRC. The stratified analysis confirmed that smoking and meat ingestion were not effect modifiers and confounders.ConclusionDrinking chlorinated water for extended years is a significant risk factor for CRC in Addis Ababa, Ethiopia. In addition, hot tap water use for showering, and swimming history are risk factors for CRC. This information is essential to design integrated interventions that consider chlorination by-products and exposure routes toward the prevention and control of CRC in Ethiopia. Initiating alternative methods to chlorine disinfection of drinking water is also essential.

Dataset Information

Colorectal Cancer and Long-Term Exposure to Trihalomethanes in Drinking Water: A Multicenter Case-Control Study in Spain and Italy.

Publications

Colorectal Cancer and Long-Term Exposure to Trihalomethanes in Drinking Water: A Multicenter Case-Control Study in Spain and Italy.

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