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Title: Oral ingestion of hexavalent chromium through drinking water and cancer mortality in an industrial area of Greece - An ecological study
Authors: Linos, Athena 
Petralias, Athanassios 
Christoforidou, Eleni 
Kouroutou, Paraskevi 
Stoltidis, Melina 
Veloudaki, Afroditi 
Tzala, Evangelia 
Karagas, Margaret R. 
Makris, Konstantinos C. 
Christophi, Costas A. 
Keywords: Carcinogenicity;Chromate
Category: Health Sciences
Field: Medical and Health Sciences
Issue Date: 2011
Source: ENVIRONMENTAL HEALTH Volume: 10 Issue: Pages:-
Abstract: Background: Hexavalent chromium is a known carcinogen when inhaled, but its carcinogenic potential when orally ingested remains controversial. Water contaminated with hexavalent chromium is a worldwide problem, making this a question of significant public health importance. Methods: We conducted an ecological mortality study within the Oinofita region of Greece, where water has been contaminated with hexavalent chromium. We calculated gender, age, and period standardized mortality ratios (SMRs) for all deaths, cancer deaths, and specific cancer types of Oinofita residents over an 11-year period (1999 - 2009), using the greater prefecture of Voiotia as the standard population. Results: A total of 474 deaths were observed. The SMR for all cause mortality was 98 (95% CI 89-107) and for all cancer mortality 114 (95% CI 94-136). The SMR for primary liver cancer was 1104 (95% CI 405-2403, p-value < 0.001). Furthermore, statistically significantly higher SMRs were identified for lung cancer (SMR = 145, 95% CI 100203, p-value = 0.047) and cancer of the kidney and other genitourinary organs among women (SMR = 368, 95% CI 119-858, p-value = 0.025). Elevated SMRs for several other cancers were also noted (lip, oral cavity and pharynx 344, stomach 121, female breast 134, prostate 128, and leukaemias 168), but these did not reach statistical significance. Conclusions: Elevated cancer mortality in the Oinofita area of Greece supports the hypothesis of hexavalent chromium carcinogenicity via the oral ingestion pathway of exposure. Further studies are needed to determine whether this association is causal, and to establish preventive guidelines and public health recommendations.
Description: This research is financially supported by the Hellenic Center for Disease Control and Prevention (H.C.D.C.P.). The authors would like to thank the Hellenic Statistical Authority for providing valuable data for this publication.
ISSN: 1476-069X
DOI: 10.1186/1476-069X-10-50
Rights: © 2011 Linos et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Type: Article
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