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The findings showed a lot of differences between the THM levels from country to country. In all EU countries, the level in drinking water was, thankfully, well below the permissible EU limit of 100 μg/L, at an average of 11.7 μg/L. However, the highest concentrations to be reported were above the limit in 9 countries, ranging from Cyprus and Hungary to Ireland, Spain, Portugal and the UK. This makes the study especially relevant to those countries, as well as over a dozen countries with high average THM levels. Attributable bladder cancer risk
The researchers now did some statistical work to find out how the average THM level was associated with the incidence of bladder cancer in each country, using the international bladder cancer database. This enabled them to estimate the number of cases that could be ascribed to THM exposure.
As a result, they found that about 6,500 bladder cancer cases each year could be said to be due to THM exposure. Of course, the attributable risk varied from country to country, with the highest burden being in Spain and the UK, at about 1,500 and 1,350 cases respectively, both because of the greater number of cases and the higher number of people. The highest attributable percentage of cases was found in Cyprus, at 23%, while Malta and Italy had 17% and Spain and Greece about 10%. The lowest attributable risk was in Denmark, at 0%, while the Netherlands, Germany, Austria and Lithuania had less than 0.5%. Implications
The researchers commented, “Over the past 20 years, major efforts have been made to reduce trihalomethanes levels in several countries of the European Union, including Spain. 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 best way to reduce these levels is to begin with the 13 countries in which the average levels are highest. Once these come down to the EU average of 11 μg/L, the estimated number of bladder cancers due to this reason could be reduced by 44%. This study thus shows the burden of bladder cancer attributable to THM exposure in tap water and suggests ways to control it. Journal reference:
Trihalomethanes in Drinking Water and Bladder Cancer Burden in the European Union 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, and Cristina M. Villanueva, https://doi.org/10.1289/EHP4495
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