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

Iro Evlampidou; Laia Font-Ribera; David Rojas-Rueda; Esther Gracia-Lavedan; Nathalie Costet; Neil Pearce; Paolo Vineis; Jouni J K Jaakkola; Francis Delloye; Konstantinos C Makris; Euripides G Stephanou; Sophia Kargaki; Frantisek Kozisek; Torben Sigsgaard; Birgitte Hansen; Jörg Schullehner; Ramon Nahkur; Catherine Galey; Christian Zwiener; Marta Vargha; Elena Righi; Gabriella Aggazzotti; Gunda Kalnina; Regina Grazuleviciene; Kinga Polanska; Dasa Gubkova; Katarina Bitenc; Emma H Goslan; Manolis Kogevinas; Cristina M Villanueva

doi:10.1289/EHP4495

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

Iro Evlampidou, Laia Font-Ribera, David Rojas-Rueda, Esther Gracia-Lavedan, Nathalie Costet, Neil Pearce, Paolo Vineis, Jouni J K Jaakkola, Francis Delloye, Konstantinos C Makris, Euripides G Stephanou, Sophia Kargaki, Frantisek Kozisek, Torben Sigsgaard, Birgitte Hansen, Jörg Schullehner, Ramon Nahkur, Catherine Galey, Christian Zwiener, Marta VarghaElena Righi, Gabriella Aggazzotti, Gunda Kalnina, Regina Grazuleviciene, Kinga Polanska, Dasa Gubkova, Katarina Bitenc, Emma H Goslan, Manolis Kogevinas, Cristina M Villanueva

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

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.

Original language	English
Article number	017001
Journal	Environmental Health Perspectives
Volume	128
Issue	1
Number of pages	14
ISSN	0091-6765
DOIs	https://doi.org/10.1289/EHP4495
Publication status	Published - Jan 2020

Keywords

BROMIDE
CHLORINATION
CONSUMPTION
DIOXIDE
DISINFECTION BY-PRODUCTS
EXPOSURE ASSESSMENT
IMPACT
METAANALYSIS
MISCLASSIFICATION
RISK

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10.1289/EHP4495

Cite this

Evlampidou, I., Font-Ribera, L., Rojas-Rueda, D., Gracia-Lavedan, E., Costet, N., Pearce, N., Vineis, P., Jaakkola, J. J. K., Delloye, F., Makris, K. C., Stephanou, E. G., Kargaki, S., Kozisek, F., Sigsgaard, T., Hansen, B., Schullehner, J., Nahkur, R., Galey, C., Zwiener, C., ... Villanueva, C. M. (2020). Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union. Environmental Health Perspectives, 128(1), Article 017001. https://doi.org/10.1289/EHP4495

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title = "Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union",

abstract = "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.",

keywords = "BROMIDE, CHLORINATION, CONSUMPTION, DIOXIDE, DISINFECTION BY-PRODUCTS, EXPOSURE ASSESSMENT, IMPACT, METAANALYSIS, MISCLASSIFICATION, RISK",

author = "Iro Evlampidou and Laia Font-Ribera and David Rojas-Rueda and Esther Gracia-Lavedan and Nathalie Costet and Neil Pearce and Paolo Vineis and Jaakkola, {Jouni J K} and Francis Delloye and Makris, {Konstantinos C} and Stephanou, {Euripides G} and Sophia Kargaki and Frantisek Kozisek and Torben Sigsgaard and Birgitte Hansen and J{\"o}rg Schullehner and Ramon Nahkur and Catherine Galey and Christian Zwiener and Marta Vargha and Elena Righi and Gabriella Aggazzotti and Gunda Kalnina and Regina Grazuleviciene and Kinga Polanska and Dasa Gubkova and Katarina Bitenc and Goslan, {Emma H} and Manolis Kogevinas and Villanueva, {Cristina M}",

year = "2020",

month = jan,

doi = "10.1289/EHP4495",

language = "English",

volume = "128",

journal = "Environmental Health Perspectives",

issn = "0091-6765",

publisher = "National Institute of Environmental Health Sciences",

number = "1",

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Evlampidou, I, Font-Ribera, L, Rojas-Rueda, D, Gracia-Lavedan, E, Costet, N, Pearce, N, Vineis, P, Jaakkola, JJK, Delloye, F, Makris, KC, Stephanou, EG, Kargaki, S, Kozisek, F, Sigsgaard, T, Hansen, B, Schullehner, J, Nahkur, R, Galey, C, Zwiener, C, Vargha, M, Righi, E, Aggazzotti, G, Kalnina, G, Grazuleviciene, R, Polanska, K, Gubkova, D, Bitenc, K, Goslan, EH, Kogevinas, M & Villanueva, CM 2020, 'Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union', Environmental Health Perspectives, vol. 128, no. 1, 017001. https://doi.org/10.1289/EHP4495

TY - JOUR

T1 - Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union

AU - Evlampidou, Iro

AU - Font-Ribera, Laia

AU - Rojas-Rueda, David

AU - Gracia-Lavedan, Esther

AU - Costet, Nathalie

AU - Pearce, Neil

AU - Vineis, Paolo

AU - Jaakkola, Jouni J K

AU - Delloye, Francis

AU - Makris, Konstantinos C

AU - Stephanou, Euripides G

AU - Kargaki, Sophia

AU - Kozisek, Frantisek

AU - Sigsgaard, Torben

AU - Hansen, Birgitte

AU - Schullehner, Jörg

AU - Nahkur, Ramon

AU - Galey, Catherine

AU - Zwiener, Christian

AU - Vargha, Marta

AU - Righi, Elena

AU - Aggazzotti, Gabriella

AU - Kalnina, Gunda

AU - Grazuleviciene, Regina

AU - Polanska, Kinga

AU - Gubkova, Dasa

AU - Bitenc, Katarina

AU - Goslan, Emma H

AU - Kogevinas, Manolis

AU - Villanueva, Cristina M

PY - 2020/1

Y1 - 2020/1

N2 - 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.

AB - 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.

KW - BROMIDE

KW - CHLORINATION

KW - CONSUMPTION

KW - DIOXIDE

KW - DISINFECTION BY-PRODUCTS

KW - EXPOSURE ASSESSMENT

KW - IMPACT

KW - METAANALYSIS

KW - MISCLASSIFICATION

KW - RISK

UR - http://www.scopus.com/inward/record.url?scp=85077907039&partnerID=8YFLogxK

U2 - 10.1289/EHP4495

DO - 10.1289/EHP4495

M3 - Journal article

C2 - 31939704

SN - 0091-6765

VL - 128

JO - Environmental Health Perspectives

JF - Environmental Health Perspectives

IS - 1

M1 - 017001

ER -

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

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Keywords

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