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

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Title: Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union.
Authors: Evlampidou, Iro1,2,3, Font-Ribera, Laia1,2,3,4, Rojas-Rueda, David1,2,3, Gracia-Lavedan, Esther1,2,3, Costet, Nathalie5, Pearce, Neil6, Vineis, Paolo7, Jaakkola, Jouni J. K.8, Delloye, Francis9, Makris, Konstantinos C.10, Stephanou, Euripides G.11,12, Kozisek, Frantisek13, Sigsgaard, Torben14, Hansen, Birgitte15, Schullehner, Jörg15,16, Nahkur, Ramon17, Galey, Catherine18, Zwiener, Christian19, Vargha, Marta20, Righi, Elena21
Source: Environmental Health Perspectives. Jan2020, Vol. 128 Issue 1, p017001-1-017001-14. 14p. 5 Charts, 1 Map.
Subject Terms: *Halocarbons, *Sterilization (Disinfection), *Water pollution, *Water supply, *Environmental exposure, Bladder tumors, Confidence intervals, Questionnaires, Data analysis software, Descriptive statistics, Odds ratio, Disease risk factors
Geographic Terms: Denmark, Ireland, Islands of the Mediterranean, Netherlands
Company/Entity: 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 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. [ABSTRACT FROM AUTHOR]
Copyright of Environmental Health Perspectives is the property of National Institute of Environmental Health Sciences and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union.
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  Data: <searchLink fieldCode="AR" term="%22Evlampidou%2C+Iro%22">Evlampidou, Iro</searchLink><relatesTo>1,2,3</relatesTo><br /><searchLink fieldCode="AR" term="%22Font-Ribera%2C+Laia%22">Font-Ribera, Laia</searchLink><relatesTo>1,2,3,4</relatesTo><br /><searchLink fieldCode="AR" term="%22Rojas-Rueda%2C+David%22">Rojas-Rueda, David</searchLink><relatesTo>1,2,3</relatesTo><br /><searchLink fieldCode="AR" term="%22Gracia-Lavedan%2C+Esther%22">Gracia-Lavedan, Esther</searchLink><relatesTo>1,2,3</relatesTo><br /><searchLink fieldCode="AR" term="%22Costet%2C+Nathalie%22">Costet, Nathalie</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Pearce%2C+Neil%22">Pearce, Neil</searchLink><relatesTo>6</relatesTo><br /><searchLink fieldCode="AR" term="%22Vineis%2C+Paolo%22">Vineis, Paolo</searchLink><relatesTo>7</relatesTo><br /><searchLink fieldCode="AR" term="%22Jaakkola%2C+Jouni+J%2E+K%2E%22">Jaakkola, Jouni J. K.</searchLink><relatesTo>8</relatesTo><br /><searchLink fieldCode="AR" term="%22Delloye%2C+Francis%22">Delloye, Francis</searchLink><relatesTo>9</relatesTo><br /><searchLink fieldCode="AR" term="%22Makris%2C+Konstantinos+C%2E%22">Makris, Konstantinos C.</searchLink><relatesTo>10</relatesTo><br /><searchLink fieldCode="AR" term="%22Stephanou%2C+Euripides+G%2E%22">Stephanou, Euripides G.</searchLink><relatesTo>11,12</relatesTo><br /><searchLink fieldCode="AR" term="%22Kozisek%2C+Frantisek%22">Kozisek, Frantisek</searchLink><relatesTo>13</relatesTo><br /><searchLink fieldCode="AR" term="%22Sigsgaard%2C+Torben%22">Sigsgaard, Torben</searchLink><relatesTo>14</relatesTo><br /><searchLink fieldCode="AR" term="%22Hansen%2C+Birgitte%22">Hansen, Birgitte</searchLink><relatesTo>15</relatesTo><br /><searchLink fieldCode="AR" term="%22Schullehner%2C+Jörg%22">Schullehner, Jörg</searchLink><relatesTo>15,16</relatesTo><br /><searchLink fieldCode="AR" term="%22Nahkur%2C+Ramon%22">Nahkur, Ramon</searchLink><relatesTo>17</relatesTo><br /><searchLink fieldCode="AR" term="%22Galey%2C+Catherine%22">Galey, Catherine</searchLink><relatesTo>18</relatesTo><br /><searchLink fieldCode="AR" term="%22Zwiener%2C+Christian%22">Zwiener, Christian</searchLink><relatesTo>19</relatesTo><br /><searchLink fieldCode="AR" term="%22Vargha%2C+Marta%22">Vargha, Marta</searchLink><relatesTo>20</relatesTo><br /><searchLink fieldCode="AR" term="%22Righi%2C+Elena%22">Righi, Elena</searchLink><relatesTo>21</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22Environmental+Health+Perspectives%22">Environmental Health Perspectives</searchLink>. Jan2020, Vol. 128 Issue 1, p017001-1-017001-14. 14p. 5 Charts, 1 Map.
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  Data: *<searchLink fieldCode="DE" term="%22Halocarbons%22">Halocarbons</searchLink><br />*<searchLink fieldCode="DE" term="%22Sterilization+%28Disinfection%29%22">Sterilization (Disinfection)</searchLink><br />*<searchLink fieldCode="DE" term="%22Water+pollution%22">Water pollution</searchLink><br />*<searchLink fieldCode="DE" term="%22Water+supply%22">Water supply</searchLink><br />*<searchLink fieldCode="DE" term="%22Environmental+exposure%22">Environmental exposure</searchLink><br /><searchLink fieldCode="DE" term="%22Bladder+tumors%22">Bladder tumors</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Questionnaires%22">Questionnaires</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Odds+ratio%22">Odds ratio</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+risk+factors%22">Disease risk factors</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22Denmark%22">Denmark</searchLink><br /><searchLink fieldCode="DE" term="%22Ireland%22">Ireland</searchLink><br /><searchLink fieldCode="DE" term="%22Islands+of+the+Mediterranean%22">Islands of the Mediterranean</searchLink><br /><searchLink fieldCode="DE" term="%22Netherlands%22">Netherlands</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22European+Union%22">European Union</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: 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 &#956g/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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Environmental Health Perspectives is the property of National Institute of Environmental Health Sciences and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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