TY - JOUR
TI - Water disinfection by-products and bladder cancer: is there a European
specificity? A pooled and meta-analysis of European case-control studies
AU - Costet, N.
AU - Villanueva, C. M.
AU - Jaakkola, J. J. K.
AU - Kogevinas,
AU - M.
AU - Cantor, K. P.
AU - King, W. D.
AU - Lynch, C. F. and
AU - Nieuwenhuijsen, M. J.
AU - Cordier, S.
JO - Annals of Occupational and Environmental Medicine
PY - 2011
VL - 68
TODO - 5
SP - 379-385
PB - B M J PUBLISHING GROUP
SN - 2052-4374
TODO - 10.1136/oem.2010.062703
TODO - null
TODO - Several epidemiological studies suggested an association between the
risk of bladder cancer and the exposure to trihalomethanes (THMs), the
main disinfection by-products (DBPs) of chlorinated water. A previous
pooled analysis of case-control studies from North America and Europe
estimated a summarized dose-response relation. For policy guidance of
drinking water disinfection in Europe and because major differences
exist in water disinfection practices and DBPs occurrence between both
continents, specific risk estimates for bladder cancer in relation to
DBPs exposure for European populations were needed. We conducted a
pooled and a two-stage random-effect meta-analyses of three European
case-control studies from France, Finland, and Spain (5467 individuals:
2381 cases and 3086 controls). Individual exposure to THMs was
calculated combining information on residential history, estimates of
the average total THMs (TTHM) level in tap water at the successive
residences and personal water consumption. A significant odds-ratio was
observed for men exposed to an average residential TTHM level > 50 mu
g/l (OR=1.47 (1.05; 2.05)) when compared to men exposed to levels <= 5
mu g/l. The linear trend of the exposure-risk association was
significant (p=0.01). Risks increased significantly for exposure levels
above 25 mu g/l and with more than 30 years of exposure to chlorinated
water, but were mainly driven by the level rather than the duration of
exposure. No significant association was found among women or with
cumulative exposure through ingestion. There was no evidence of a
differential exposure-response relation for TTHM and bladder cancer in
Europe and North America. Consequently, a global exposure-risk relation
based on 4351 cases and 7055 controls is now available.
ER -