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https://hdl.handle.net/20.500.14279/19443| Title: | Trihalomethanes in drinking water and bladder cancer burden in the European Union | Authors: | Evlampidou, Iro Font-Ribera, Laia Rojas-Rueda, David Gracia-Lavedan, Esther Costet, Nathalie Pearce, Neil Vineis, Paolo Jaakkola, J. J.K. Delloye, Francis Makris, Konstantinos C. Stephanou, Euripides G. Kargaki, Sophia Kožíšek, František Sigsgaard, Torben Hansen, Birgitte Schullehner, Jörg Nahkur, Ramon Galey, Catherine Zwiener, Christian Vargha, Márta Righi, Elena Aggazzotti, Gabriella Kalnina, Gunda Gražulevičieně, Regina Polańska, Kinga Gubkova, Dasa |
Major Field of Science: | Medical and Health Sciences | Field Category: | Health Sciences | Keywords: | Chlorine;Chlorine dioxide;Drinking water;Hypochlorite;Trihalomethane;Drinking water | Issue Date: | Jan-2020 | Source: | Environmental Health Perspectives, 2020, vol. 128, no. 1, articl. no. 017001 | Volume: | 128 | Issue: | 1 | Journal: | Environmental Health Perspectives | URI: | https://hdl.handle.net/20.500.14279/19443 | ISSN: | 15529924 | DOI: | 10.1289/EHP4495 | Rights: | Attribution-NonCommercial-NoDerivatives 4.0 International | Type: | Article | Affiliation : | ISGlobal Universitat Pompeu Fabra CIBER Epidemiología y Salud Pública (CIBERESP) Hospital Del Mar Research Institute (IMIM) Université de Rennes London School of Hygiene and Tropical Medicine Imperial College London University of Oulu Service Public de Wallonie Cyprus University of Technology University of Crete The Cyprus Institute National Institute of Public Health Prague Aarhus University Geological Survey of Denmark and Greenland Estonian Ministry of Social Affairs Santé Publique France Eberhard Karls University Tübingen National Public Health Institute University of Modena and Reggio Emilia Ministry of Health of the Republic Latvia Vytautas Magnus University Nofer Institute of Occupational Medicine in Łódź Public Health Authority of the Slovak Republic National Institute of Public Health Ljubljana Cranfield University |
Funding: | 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 μg/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. | Publication Type: | Peer Reviewed |
| Appears in Collections: | Άρθρα/Articles |
Files in This Item:
| File | Description | Size | Format | |
|---|---|---|---|---|
| EHP4495.pdf | Fulltext | 504.44 kB | Adobe PDF | View/Open |
| ehp4495.smcontents.508.pdf | Supplement | 145 kB | Adobe PDF | View/Open |
| ehp4495.s001.acco.pdf | Supplement | 417.12 kB | Adobe PDF | View/Open |
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