Exposure to chemicals in drinking water associated with 5% of annual bladder cancer burden in Europe

January 15, 2020

Each year, more than 6,500 cases of bladder cancer--nearly 5% of all cases in Europe-- can be attributed to exposure to trihalomethanes (THMs) in drinking water. This is one of the conclusions of a large-scale study led by the Barcelona Institute for Global Health (ISGlobal), a centre supported by "la Caixa", that analysed for the first time the presence of these chemical compounds in the tap water of 26 European Union countries.

Trihalomethanes are formed as an unintended consequence of water disinfection. Earlier research has found an association between long-term exposure to THMs--whether through ingestion, inhalation or dermal absorption--and increased risk of bladder cancer.

The authors of the new study, published in Environmental Health Perspectives, analysed recent data on trihalomethanes levels in European municipal tap water and estimated the burden of disease for bladder cancer attributable to exposure to these compounds.

"The biggest challenge was collecting representative data on national trihalomethanes levels for all EU countries", explained Cristina Villanueva, the ISGlobal researcher who coordinated the study. "We hope that these data will become more readily available in the future."

The researchers sent questionnaires to bodies responsible for municipal water quality requesting information on the concentration of total and individual trihalomethanes (chloroform, bromodichloromethane, dibromochloromethane, and bromoform) at the tap, in the distribution network and at water treatment plants. Complementary data was obtained from other sources ¬(open data online, reports, scientific literature, etc.).

Trihalomethanes data for 2005 to 2018 were obtained for 26 European Union countries--all except Bulgaria and Romania, where less information was available--covering 75% of the population.

The findings revealed considerable differences between countries. The average level of trihalomethanes in drinking water in all countries was well below the maximum permissible limit in the EU--11.7 μg/L versus 100 μg/L-- but the maximum reported concentrations did exceed the limit in nine countries (Cyprus, Estonia, Hungary, Ireland, Italy, Poland, Portugal, Spain and the United Kingdom).

Lead author Iro Evlampidou described the study as being "of particular interest to countries with high average levels of trihalomethanes concentrations recorded in tap water."

Association with Bladder Cancer

The number of attributable bladder cancer cases was estimated through a statistical calculation linking average levels of trihalomethanes with the international information available of bladder cancer incidence rates for each country.

In total, the researchers estimated that 6,561 bladder cancer cases per year are attributable to trihalomethanes exposure in the European Union. Considerable differences were found between countries. Spain and the United Kingdom had the largest number of attributable cases of bladder cancer--1,482 and 1,356, respectively--due in part to the high incidence of bladder cancer and their large population.

The countries with the highest percentage of bladder cancer cases attributable to THM exposure were Cyprus (23%), Malta (17%), Ireland (17%), Spain (11%) and Greece (10%). At the opposite extreme, there were Denmark (0%), Netherlands (0.1%), Germany (0.2%), Austria (0.4%) and Lithuania (0.4%).

"Over the past 20 years, major efforts have been made to reduce trihalomethanes levels in several countries of the European Union, including Spain", commented ISGlobal researcher Manolis Kogevinas. "However, the current levels in certain countries could still lead to considerable bladder cancer burden, which could be prevented by optimising water treatment, disinfection and distribution practices and other measures."

The authors of the study recommended that efforts to reduce trihalomethanes levels should focus on countries with the highest average levels. If the 13 countries with the highest averages were to reduce their THM levels to the EU average, the researchers estimate that 2,868 annual attributable bladder cancer cases--44% of the total-- could potentially be avoided.
-end-
Reference

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. Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union. Environmental Health Perspectives, January 2020. https://doi.org/10.1289/EHP4495.

Barcelona Institute for Global Health (ISGlobal)

Related Bladder Cancer Articles from Brightsurf:

Effectiveness of gemcitabine & daily RT for bladder preservation in muscle-invasive bladder cancer
Bladder preservation with trimodality therapy can be a safe and effective alternative to cystectomy for selected patients with muscle-invasive bladder cancer.

Anthrax may be the next tool in the fight against bladder cancer
Researchers at Purdue University have come up with a way to combine the anthrax toxin with a growth factor to kill bladder cancer cells and tumors.

Effectiveness of a new bladder cancer treatment demonstrated
Demonstrated the effectiveness of a drug for treating metastatic bladder cancer in patients who did not respond to the usual treatment.

Lifting the lid on bladder cancer support
Bladder cancer is a painful and sometimes life-threatening condition that patients can find difficult to talk about, with many becoming homebound as they cope with debilitating side effects such as incontinence.

How genomics profiling can help identify the best treatment for bladder cancer
A new computational tool -- a single-patient classifier -- effectively enables physicians to assign a bladder cancer subtype to an individual patient's cancer using that patient's genomic data.

Early menopause in smokers linked to bladder cancer
Research shows that experiencing menopause before the age of 45 is associated with a higher risk of bladder cancer.

Olfactory receptor as therapeutic target in bladder cancer
Researchers from Bochum have detected an olfactory receptor in the human bladder that might prove useful for bladder cancer therapy and diagnosis.

Bladder cancer model could pave the way for better drug efficacy studies
In the journal Cancer Research, UNC Lineberger Comprehensive Cancer Center researchers report they have developed a model of luminal bladder cancer, one of the two subtypes of advanced bladder cancer.

Genetic fixer-uppers may help predict bladder cancer prognosis
Mutations in genes that help repair damage to DNA may aid in predicting the prognosis of patients with bladder and other related cancers, according to researchers, who found that bladder cancer patients who had mutations in their ATM or RB1 genes -- proteins that help repair DNA damage when they're functioning normally -- tended not to live as long as patients without the mutations.

Simultaneous chemo and immunotherapy may be better for some with metastatic bladder cancer
Researchers from Mount Sinai and Sema4, a health information company and Mount Sinai venture, have discovered that giving metastatic bladder cancer patients simultaneous chemotherapy and immunotherapy is safe and that patients whose tumors have certain genetic mutations may respond particularly well to this combination approach, according to the results of a clinical trial published in European Urology.

Read More: Bladder Cancer News and Bladder Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.