Bladder Cancer and Exposure to Water Disinfection By-Products through Ingestion, Bathing, Showering, and Swimming in Pools
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Bladder cancer has been associated with exposure to chlorination by-products in drinking water, and experimental evidence suggests that exposure also occurs through inhalation and dermal absorption. The authors examined whether bladder cancer risk was associated with exposure to trihalomethanes (THMs) through ingestion of water and through inhalation and dermal absorption during showering, bathing, and swimming in pools. Lifetime personal information on water consumption and water-related habits was collected for 1,219 cases and 1,271 controls in a 1998-2001 case-control study in Spain and was linked with THM levels in geographic study areas. Long-term THM exposure was associated with a twofold bladder cancer risk, with an odds ratio of 2.10 (95% confidence interval: 1.09, 4.02) for average household THM levels of >49 versus < or =8 micro g/liter. Compared with subjects not drinking chlorinated water, subjects with THM exposure of >35 micro g/day through ingestion had an odds ratio of 1.35 (95% confidence interval: 0.92, 1.99). The odds ratio for duration of shower or bath weighted by residential THM level was 1.83 (95% confidence interval: 1.17, 2.87) for the highest compared with the lowest quartile. Swimming in pools was associated with an odds ratio of 1.57 (95% confidence interval: 1.18, 2.09). Bladder cancer risk was associated with long-term exposure to THMs in chlorinated water at levels regularly occurring in industrialized countries.
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THMs and HAAs are suspected to have various health effects, mainly carcinogenic risk or adverse reproductive outcomes.
“THMs and HAAs are suspected to have various health effects, mainly regarding carcinogenic risk (e.g., bladder cancer) or adverse reproductive outcomes (e.g., intra-uterine growth retardation) [6,7].”
From Occurrence and Spatial and Temporal Variations of Disinfection By-Products in the Water and Air of Two Indoor Swimming Pools (2012) · cites this paper as [6]
Long-time THM exposure was related to a twofold-higher incidence of bladder cancer, with an OR of 2.10 and 95% CI of 1.09 to 4.02 for mean household THM concentrations of >49 and ≤8 μg/liter.
“Long-time THM exposure was related to a twofold-higher incidence of bladder cancer, with an OR of 2.10 and 95% CI of 1.09 to 4.02 for mean household THM concentrations of >49 and ≤8 μg/liter.”
From Overview of emerging contaminants and associated human health effects (2015) · cites this paper as [38]
Bladder cancer was related to long-duration exposure to THMs from chlorinated water typical of the exposure experienced in developed areas.
“Bladder cancer was related to long-duration exposure to THMs from chlorinated water typical of the exposure experienced in developed areas.”
From Overview of emerging contaminants and associated human health effects (2015) · cites this paper as [38]
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Self-citation
- Authors
- Villanueva, C. M., Cantor, K. P., Grimalt, J. O., Malats, N., Silverman, D., Tardon, A., Garcia-Closas, R., Serra, C., Carrato, A., Castano-Vinyals, G., Marcos, R., Rothman, N., Real, F. X., Dosemeci, M., & Kogevinas, M.
- Affiliations
- Center for Research in Environmental Epidemiology (ES)
- National Cancer Institute (US)
- Consejo Superior de Investigaciones Científicas (ES)
- Universitat Pompeu Fabra (ES)
- Hospital General Universitario de Elche (ES)
- Universitat Autònoma de Barcelona (ES)
- University of Crete (GR)
- ORCID
- Venue
- American Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-09-27
- Volume
- 165
- Issue
- 2
- Pages
- 148-156
- ISSN
- 0002-9262 (ISSN-L)
- 1476-6256
- OpenAlex
- W2131702888
- Cited by
- 596
- References
- 22
- Citations by year
- 2026: 17 · 2025: 28 · 2024: 24 · 2023: 33 · 2022: 33 · 2021: 34 · 2020: 31 · 2019: 48 · 2018: 39 · 2017: 42 · 2016: 36 · 2015: 31 · 2014: 28 · 2013: 29 · 2012: 26
- FWCI
- 12.15
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- cc-by-nc-nd
- Locations
- American Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Consultation of the Doctoral Thesis Database (TESEO) (Ministerio de Educación, Cultura y Deporte) (submittedVersion, cc-by-nc-nd)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
- Funders
- National Institutes of Health
- Johns Hopkins Bloomberg School of Public Health
- National Cancer Institute (N02-CP-11015)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Water Treatment and Disinfection
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Carcinogens and Genotoxicity Assessment
- Physical Sciences › Environmental Science › Environmental Chemistry › Arsenic contamination and mitigation
- Keywords
- bladder cancer, trihalomethanes, water disinfection by-products, chlorination by-products, drinking water, oral exposure, showering, bathing, inhalation exposure, percutaneous absorption, cancer risk
- MeSH terms
- Adult, Aged, Aged, 80 and over, Baths, Urinary Bladder Neoplasms, Disinfection, Drinking, Environmental Exposure, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Risk Factors, Spain, Swimming Pools, Incidence, Water Purification
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