American Journal of Epidemiology Advance Access published online on November 1, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj364
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1 Centre for Research in Environmental Epidemiology, Municipal Institute of Medical Research, Barcelona, Spain
* To whom correspondence should be addressed. 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
Received March 27, 2006
Accepted June 8, 2006
ORIGINAL CONTRIBUTIONS
Bladder Cancer and Exposure to Water Disinfection By-Products through Ingestion, Bathing, Showering, and Swimming in Pools
Cristina M. Villanueva 1, Kenneth P. Cantor 2, Joan O. Grimalt 3, Nuria Malats 1, Debra Silverman 2, Adonina Tardon 4, Reina Garcia-Closas 5, Consol Serra 6, Alfredo Carrato 7, Gemma Castaño-Vinyals 1, Ricard Marcos 8, Nathaniel Rothman 2, Francisco X. Real 9, Mustafa Dosemeci 2, and Manolis Kogevinas 10 *
2 Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD
3 Department of Environmental Chemistry, Institute of Chemical and Environmental Research (CSIC), Barcelona, Spain
4 Department of Preventive Medicine and Public Health, Universidad de Oviedo, Oviedo, Spain
5 Department of Preventive Medicine, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
6 Unit of Research in Occupational Health, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Corporació Parc Taulí, Sabadell, Spain
7 Department of Medical Oncology, Hospital General de Elche, Elche, Spain
8 Mutagenesis Group, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
9 Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Cellular and Molecular Biology Research Unit, Municipal Institute of Medical Research (IMIM), Barcelona, Spain
10 Centre for Research in Environmental Epidemiology, Municipal Institute of Medical Research, Barcelona, Spain; Department of Social Medicine, Medical School, University of Crete, Heraklion, Crete, Greece
Manolis Kogevinas, E-mail: kogevinas{at}imim.es
Abstract 
8 µg/liter. Compared with subjects not drinking chlorinated water, subjects with THM exposure of >35 µg/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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