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

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  • Iro Evlampidou, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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  • Laia Font-Ribera, Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
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  • David Rojas-Rueda, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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  • Esther Gracia-Lavedan, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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  • Nathalie Costet, Université de Rennes, Institut national de la santé et de la recherche médicale (Inserm), École des hautes études en santé publique (EHESP), Rennes, France.
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  • Neil Pearce, London School of Hygiene and Tropical Medicine
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  • Paolo Vineis, Imperial Coll London, Imperial College London, UKDRI
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  • Jouni J K Jaakkola, Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland.
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  • Francis Delloye, Service Public de Wallonie, Direction générale de l'Agriculture, des Ressources naturelles et de l'Environnement, Département de l'Environnement et de l'Eau, Jambes, Belgium.
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  • Konstantinos C Makris, Water and Health Laboratory, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus.
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  • Euripides G Stephanou, The Cyprus Institute, Aglantzia-Nicosia, Cyprus.
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  • Sophia Kargaki, Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Heraklion, Greece.
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  • Frantisek Kozisek, Laboratory of Bacterial Genetics, National Institute of Public Health, Prague and Department of Laboratory Medicine, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
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  • Torben Sigsgaard
  • Birgitte Hansen, Geological Survey of Denmark and Greenland (GEUS), Aarhus, Denmark
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  • Jörg Schullehner
  • Ramon Nahkur, Public Health Department, Estonian Ministry of Social Affairs, Tallinn, Estonia.
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  • Catherine Galey, Santé Publique France (French National Public Health Agency), Saint-Maurice, France.
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  • Christian Zwiener, Environmental Analytical Chemistry, Center for Applied Geosciences (ZAG), Eberhard-Karls-University Tuebingen, Tuebingen, Germany.
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  • Marta Vargha, National Public Health Center, Budapest, Hungary.
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  • Elena Righi, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
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  • Gabriella Aggazzotti, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
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  • Gunda Kalnina, Public Health Division, Ministry of Health of the Republic Latvia, Health Inspectorate, Riga, Latvia.
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  • Regina Grazuleviciene, Department of Environmental Sciences, Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania.
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  • Kinga Polanska, Nofer Institute of Occupational Medicine, Department of Environmental Epidemiology, Lodz, Poland.
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  • Dasa Gubkova, Public Health Authority of the Slovak Republic, Bratislava, Slovak Republic.
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  • Katarina Bitenc, National Institute of Public Health, Ljubljana, Slovenia.
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  • Emma H Goslan, Cranfield Water Science Institute, Cranfield University, Cranfield, Bedford, UK.
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  • Manolis Kogevinas, Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
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  • Cristina M Villanueva, Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.

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 μ 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.

OriginalsprogEngelsk
Artikelnummer017001
TidsskriftEnvironmental Health Perspectives
Vol/bind128
Nummer1
Antal sider14
ISSN0091-6765
DOI
StatusUdgivet - jan. 2020

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