Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 1997 Jul;87(7):1168–1176. doi: 10.2105/ajph.87.7.1168

The association of drinking water source and chlorination by-products with cancer incidence among postmenopausal women in Iowa: a prospective cohort study.

T J Doyle 1, W Zheng 1, J R Cerhan 1, C P Hong 1, T A Sellers 1, L H Kushi 1, A R Folsom 1
PMCID: PMC1380892  PMID: 9240108

Abstract

OBJECTIVES: This study assessed the association of drinking water source and chlorination by-product exposure with cancer incidence. METHODS: A cohort of 28,237 Iowa women reported their drinking water source. Exposure to chlorination by-products was determined from statewide water quality data. RESULTS: In comparison with women who used municipal ground-water sources, women with municipal surface water sources were at an increased risk of colon cancer and all cancers combined. A clear dose-response relation was observed between four categories of increasing chloroform levels in finished drinking water and the risk of colon cancer and all cancers combined. The relative risks were 1.00, 1.06, 1.39, and 1.68 for colon cancer and 1.00, 1.04, 1.24, and 1.25 for total cancers. No consistent association with either water source or chloroform concentration was observed for other cancer sites. CONCLUSIONS: These results suggest that exposure to chlorination by-products in drinking water is associated with increased risk of colon cancer.

Full text

PDF
1168

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bostick R. M., Potter J. D., Kushi L. H., Sellers T. A., Steinmetz K. A., McKenzie D. R., Gapstur S. M., Folsom A. R. Sugar, meat, and fat intake, and non-dietary risk factors for colon cancer incidence in Iowa women (United States). Cancer Causes Control. 1994 Jan;5(1):38–52. doi: 10.1007/BF01830725. [DOI] [PubMed] [Google Scholar]
  2. Bostick R. M., Potter J. D., McKenzie D. R., Sellers T. A., Kushi L. H., Steinmetz K. A., Folsom A. R. Reduced risk of colon cancer with high intake of vitamin E: the Iowa Women's Health Study. Cancer Res. 1993 Sep 15;53(18):4230–4237. [PubMed] [Google Scholar]
  3. Bostick R. M., Potter J. D., Sellers T. A., McKenzie D. R., Kushi L. H., Folsom A. R. Relation of calcium, vitamin D, and dairy food intake to incidence of colon cancer among older women. The Iowa Women's Health Study. Am J Epidemiol. 1993 Jun 15;137(12):1302–1317. doi: 10.1093/oxfordjournals.aje.a116640. [DOI] [PubMed] [Google Scholar]
  4. Cantor K. P., Hoover R., Hartge P., Mason T. J., Silverman D. T., Altman R., Austin D. F., Child M. A., Key C. R., Marrett L. D. Bladder cancer, drinking water source, and tap water consumption: a case-control study. J Natl Cancer Inst. 1987 Dec;79(6):1269–1279. [PubMed] [Google Scholar]
  5. Cantor K. P., Hoover R., Mason T. J., McCabe L. J. Associations of cancer mortality with halomethanes in drinking water. J Natl Cancer Inst. 1978 Oct;61(4):979–985. [PubMed] [Google Scholar]
  6. Cech I., Holguin A. H., Littell A. S., Henry J. P., O'Connell J. Health significance of chlorination byproducts in drinking water: the Houston experience. Int J Epidemiol. 1987 Jun;16(2):198–207. doi: 10.1093/ije/16.2.198. [DOI] [PubMed] [Google Scholar]
  7. Cerhan J. R., Wallace R. B., Folsom A. R., Potter J. D., Munger R. G., Prineas R. J. Transfusion history and cancer risk in older women. Ann Intern Med. 1993 Jul 1;119(1):8–15. doi: 10.7326/0003-4819-119-1-199307010-00002. [DOI] [PubMed] [Google Scholar]
  8. Corley R. A., Mendrala A. L., Smith F. A., Staats D. A., Gargas M. L., Conolly R. B., Andersen M. E., Reitz R. H. Development of a physiologically based pharmacokinetic model for chloroform. Toxicol Appl Pharmacol. 1990 May;103(3):512–527. doi: 10.1016/0041-008x(90)90324-n. [DOI] [PubMed] [Google Scholar]
  9. Dunnick J. K., Melnick R. L. Assessment of the carcinogenic potential of chlorinated water: experimental studies of chlorine, chloramine, and trihalomethanes. J Natl Cancer Inst. 1993 May 19;85(10):817–822. doi: 10.1093/jnci/85.10.817. [DOI] [PubMed] [Google Scholar]
  10. Flaten T. P. Chlorination of drinking water and cancer incidence in Norway. Int J Epidemiol. 1992 Feb;21(1):6–15. doi: 10.1093/ije/21.1.6. [DOI] [PubMed] [Google Scholar]
  11. Flegal K. M., Brownie C., Haas J. D. The effects of exposure misclassification on estimates of relative risk. Am J Epidemiol. 1986 Apr;123(4):736–751. doi: 10.1093/oxfordjournals.aje.a114294. [DOI] [PubMed] [Google Scholar]
  12. Folsom A. R., Kaye S. A., Sellers T. A., Hong C. P., Cerhan J. R., Potter J. D., Prineas R. J. Body fat distribution and 5-year risk of death in older women. JAMA. 1993 Jan 27;269(4):483–487. [PubMed] [Google Scholar]
  13. Hoover R. N., Strasser P. H. Artificial sweeteners and human bladder cancer. Preliminary results. Lancet. 1980 Apr 19;1(8173):837–840. doi: 10.1016/s0140-6736(80)91350-1. [DOI] [PubMed] [Google Scholar]
  14. Jo W. K., Weisel C. P., Lioy P. J. Chloroform exposure and the health risk associated with multiple uses of chlorinated tap water. Risk Anal. 1990 Dec;10(4):581–585. doi: 10.1111/j.1539-6924.1990.tb00542.x. [DOI] [PubMed] [Google Scholar]
  15. Jo W. K., Weisel C. P., Lioy P. J. Routes of chloroform exposure and body burden from showering with chlorinated tap water. Risk Anal. 1990 Dec;10(4):575–580. doi: 10.1111/j.1539-6924.1990.tb00541.x. [DOI] [PubMed] [Google Scholar]
  16. Koivusalo M. T., Jaakkola J. J., Vartiainen T. Drinking water mutagenicity in past exposure assessment of the studies on drinking water and cancer: application and evaluation in Finland. Environ Res. 1994 Jan;64(1):90–101. doi: 10.1006/enrs.1994.1008. [DOI] [PubMed] [Google Scholar]
  17. Koivusalo M., Jaakkola J. J., Vartiainen T., Hakulinen T., Karjalainen S., Pukkala E., Tuomisto J. Drinking water mutagenicity and gastrointestinal and urinary tract cancers: an ecological study in Finland. Am J Public Health. 1994 Aug;84(8):1223–1228. doi: 10.2105/ajph.84.8.1223. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kushi L. H., Sellers T. A., Potter J. D., Nelson C. L., Munger R. G., Kaye S. A., Folsom A. R. Dietary fat and postmenopausal breast cancer. J Natl Cancer Inst. 1992 Jul 15;84(14):1092–1099. doi: 10.1093/jnci/84.14.1092. [DOI] [PubMed] [Google Scholar]
  19. Lawrence C. E., Taylor P. R., Trock B. J., Reilly A. A. Trihalomethanes in drinking water and human colorectal cancer. J Natl Cancer Inst. 1984 Mar;72(3):563–568. [PubMed] [Google Scholar]
  20. Lynch C. F., Woolson R. F., O'Gorman T., Cantor K. P. Chlorinated drinking water and bladder cancer: effect of misclassification on risk estimates. Arch Environ Health. 1989 Jul-Aug;44(4):252–259. doi: 10.1080/00039896.1989.9935891. [DOI] [PubMed] [Google Scholar]
  21. Lévesque B., Ayotte P., LeBlanc A., Dewailly E., Prud'Homme D., Lavoie R., Allaire S., Levallois P. Evaluation of dermal and respiratory chloroform exposure in humans. Environ Health Perspect. 1994 Dec;102(12):1082–1087. doi: 10.1289/ehp.102-1567469. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. McGeehin M. A., Reif J. S., Becher J. C., Mangione E. J. Case-control study of bladder cancer and water disinfection methods in Colorado. Am J Epidemiol. 1993 Oct 1;138(7):492–501. doi: 10.1093/oxfordjournals.aje.a116883. [DOI] [PubMed] [Google Scholar]
  23. Melnick RL, Dunnick JK, Sandler DP, Elwell MR, Barrett JC. Trihalomethanes and Other Environmental Factors That Contribute to Colorectal Cancer. Environ Health Perspect. 1994 Jun;102(6-7):586–588. doi: 10.1289/ehp.94102586. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Morris R. D., Audet A. M., Angelillo I. F., Chalmers T. C., Mosteller F. Chlorination, chlorination by-products, and cancer: a meta-analysis. Am J Public Health. 1992 Jul;82(7):955–963. doi: 10.2105/ajph.82.7.955. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Nelemans P. J., Rampen F. H., Groenendal H., Kiemeney L. A., Ruiter D. J., Verbeek A. L. Swimming and the risk of cutaneous melanoma. Melanoma Res. 1994 Oct;4(5):281–286. doi: 10.1097/00008390-199410000-00002. [DOI] [PubMed] [Google Scholar]
  26. Sellers T. A., Kushi L. H., Potter J. D., Kaye S. A., Nelson C. L., McGovern P. G., Folsom A. R. Effect of family history, body-fat distribution, and reproductive factors on the risk of postmenopausal breast cancer. N Engl J Med. 1992 May 14;326(20):1323–1329. doi: 10.1056/NEJM199205143262004. [DOI] [PubMed] [Google Scholar]
  27. Steinmetz K. A., Kushi L. H., Bostick R. M., Folsom A. R., Potter J. D. Vegetables, fruit, and colon cancer in the Iowa Women's Health Study. Am J Epidemiol. 1994 Jan 1;139(1):1–15. doi: 10.1093/oxfordjournals.aje.a116921. [DOI] [PubMed] [Google Scholar]
  28. Steinmetz K. A., Potter J. D., Folsom A. R. Vegetables, fruit, and lung cancer in the Iowa Women's Health Study. Cancer Res. 1993 Feb 1;53(3):536–543. [PubMed] [Google Scholar]
  29. Wilkins J. R., 3rd, Comstock G. W. Source of drinking water at home and site-specific cancer incidence in Washington County, Maryland. Am J Epidemiol. 1981 Aug;114(2):178–190. doi: 10.1093/oxfordjournals.aje.a113181. [DOI] [PubMed] [Google Scholar]
  30. Wilkins J. R., 3rd, Reiches N. A., Kruse C. W. Organic chemical contaminants in drinking water and cancer. Am J Epidemiol. 1979 Oct;110(4):420–448. doi: 10.1093/oxfordjournals.aje.a112825. [DOI] [PubMed] [Google Scholar]
  31. Willett W., Stampfer M. J. Total energy intake: implications for epidemiologic analyses. Am J Epidemiol. 1986 Jul;124(1):17–27. doi: 10.1093/oxfordjournals.aje.a114366. [DOI] [PubMed] [Google Scholar]
  32. Young T. B., Kanarek M. S., Tsiatis A. A. Epidemiologic study of drinking water chlorination and Wisconsin female cancer mortality. J Natl Cancer Inst. 1981 Dec;67(6):1191–1198. [PubMed] [Google Scholar]
  33. Young T. B., Wolf D. A., Kanarek M. S. Case-control study of colon cancer and drinking water trihalomethanes in Wisconsin. Int J Epidemiol. 1987 Jun;16(2):190–197. doi: 10.1093/ije/16.2.190. [DOI] [PubMed] [Google Scholar]
  34. Zheng W., Kushi L. H., Potter J. D., Sellers T. A., Doyle T. J., Bostick R. M., Folsom A. R. Dietary intake of energy and animal foods and endometrial cancer incidence. The Iowa women's health study. Am J Epidemiol. 1995 Aug 15;142(4):388–394. doi: 10.1093/oxfordjournals.aje.a117646. [DOI] [PubMed] [Google Scholar]
  35. Zierler S., Feingold L., Danley R. A., Craun G. Bladder cancer in Massachusetts related to chlorinated and chloraminated drinking water: a case-control study. Arch Environ Health. 1988 Mar-Apr;43(2):195–200. doi: 10.1080/00039896.1988.9935853. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES