Title Water chlorination: essential process or cancer hazard?
Author Bull RJ; Birnbaum LS; Cantor KP; Rose JB; Butterworth BE; Pegram R; Tuomisto J
Source Fundam Appl Toxicol, 1995 Dec, 28:2, 155-66
The paper discusses trihalomethanes and disinfection by-products produced by chlorination. Alternatives to chlorination have their own risks associated with their by-products that are even less well established than for chlorination. Moreover, the use of these alternatives vary in their effectiveness and some require greater sophistication in their application. This can mean less protection to public health as a result of inappropriate application and control. Therefore, hazards associated with the use of such a clearly beneficial process as chlorination must be carefully considered not only in an absolute sense, but also in the context of alternative approaches for producing a safe drinking water.

Title Case-control study of bladder cancer and water disinfection methods in Colorado.
Author McGeehin MA; Reif JS; Becher JC; Mangione EJ
Source Am J Epidemiol, 1993 Oct 1, 138:7, 492-501
The paper discusses a population-based case-control study of bladder cancer and drinking water disinfection methods conducted during 1990-1991 in Colorado. A total of 327 histologically verified bladder cancer cases were frequency matched by age and sex to 261 other-cancer controls. After adjustment for cigarette smoking, tap water and coffee consumption, and medical history factors by logistic regression, years of exposure to chlorinated surface water were significantly associated with risk for bladder cancer (p = 0.0007). The odds ratio for bladder cancer increased for longer durations of exposure to a level of 1.8 (95% confidence interval 1.1-2.9) for more than 30 years of exposure to chlorinated surface water compared with no exposure. The increased bladder cancer risk was similar for males and females and for nonsmokers and smokers. Levels of total trihalomethanes, nitrates, and residual chlorine were not associated with bladder cancer risk after controlling for years of exposure to chlorinated water. Language of Publication English Unique Identifier 94026984

Title The association of waterborne chloroform with intrauterine growth retardation.
Author Kramer MD; Lynch CF; Isacson P; Hanson JW
Source Epidemiology, 1992 Sep, 3:5, 407-13
The paper discusses the association of waterborne chloroform with low birthweight (less than 2,500 gm), prematurity (less than 37 weeks gestation), and intrauterine growth retardation (less than 5th percentile of weight for gestational age). After adjustment for maternal age, parity, adequacy of prenatal care, marital status, education, and maternal smoking by multiple logistic regression, residence in municipalities where chloroform concentrations were greater than or equal to 10 micrograms/liter was associated with an increased risk for intrauterine growth retardation (odds ratio = 1.8, 95% confidence interval = 1.1-2.9). The limitations of the study were discussed.

Title Public drinking water contamination and birth outcomes.
Author Bove FJ; Fulcomer MC; Klotz JB; Esmart J; Dufficy EM; Savrin JE
Source Am J Epidemiol, 1995 May 1, 141:9, 850-62
The paper discusses the effects of public drinking water contamination on birth outcomes in an area of northern New Jersey

Title Epidemiological studies on cancer and organic compounds in U.S. drinking waters.
Author Williamson SJ
Source Sci Total Environ, 1981 Apr, 18:, 187-203
The paper discusses two national surveys of U. S. drinking waters conducted to determine the presence and concentration levels of organic compounds, particularly trihalomethanes. Most drinking water supplies from surface water sources have been shown to contain numerous organic compounds at very low levels. Chloroform is present in virtually all drinking water supplies that are treated with chlorine as a disinfectant. A summary of fourteen epidemiological studies conducted to determine if there is a positive association between drinking water and increased cancer mortality studies is presented, which indicates that there is potentially an increased risk of bladder, colon, and rectum cancer from drinking waters containing trihalomethanes.

Title Problems in assessing the risks of mixtures of contaminants in drinking water.
Author Vanderslice RR; Orme J; Ohanian EV; Sonich-Mullin C
Source Toxicol Ind Health, 1989 Oct, 5:5, 747-55
Partial abstract In conducting risk assessments on drinking water contaminants, the U.S. Environmental Protection Agency (EPA) attempts to evaluate all available toxicity data to develop Health Advisory (HA) and Maximum Contaminant Level Goal (MCLG) values. Potential toxic interactions between drinking water contaminants are difficult to predict because experimental studies are generally performed only at high doses relative to environmental levels. Although the contamination of drinking water involves mixtures of contaminants, drinking water regulations are generally based on an assessment of the risks of individual contaminants. This paper discusses three issues of major concern to the EPA: the synergistic effects of solvent mixtures, vehicle effects in laboratory studies, and setting standards for essential trace nutrients where the absorption and/or toxicity are affected by an individual's nutritional status or other dietary components.

Title Associations of cancer mortality with halomethanes in drinking water.
Author Cantor KP; Hoover R; Mason TJ; McCabe LJ
Source J Natl Cancer Inst, 1978 Oct, 61:4, 979-85
The paper discusses associations between site- and sex-specific county cancer mortality rates and levels of trihalomethanes (THM's) in drinking water examined after adjustment of rates for the influence of multiple socioeconomic, industrial, and demographic factors. Positive correlations with THM levels were observed for several cancers, including bladder and brain cancers in both sexes, and non-Hodgkin's lymphoma and kidney cancer in males. Stomach cancer in females showed a negative association.

Title Cancer mortality and the method of chlorination of public drinking water: St. Louis City and St. Louis County, Missouri.
Author Marienfeld CJ; Collins M; Wright H; Reddy R; Shoop G; Rust P
Source J Environ Pathol Toxicol Oncol, 1986 Sep-Dec, 7:1-2, 141-57
The paper discusses an apparent association between a probable increase in trihalomethane production in the St. Louis County water since 1955 and an increase in specific cancer (large bowel, liver and bladder cancers) rates which exceed the increases in the St. Louis City rates. This does not imply causality but is in general agreement with other studies which have examined water chlorination and cancer mortality.