title: Influence of nitrate levels in drinking water on urological malignancies: a community-based cohort study.
abstract: OBJECTIVE
  To evaluate the effect of nitrate levels in the drinking water on the incidence of urological malignancies in a German community.
  
  
  METHODS
  For 28 years (1957-86) the community of Bocholt, Germany (70,000 inhabitants) had a drinking water supply with different nitrate levels, i.e. 60 mg/L in group A (57,253 inhabitants) and 10 mg/L in group B (10,037 inhabitants). All newly diagnosed cases of urological malignancies were registered from 1986 to 1997. The incidence was calculated using an age standardization based on the German population.
  
  
  RESULTS
  In all, there were 527 urological malignancies recorded (urothelial cancer 39.8%, renal cell carcinoma 10.8%, testicular tumours 8.0%, penile carcinoma 1.7%, prostate cancer 39.7%). The incidence per 100,000 inhabitants/year of urinary tract tumours was 33.8 in group A and only 17.1 in group B (relative risk, RR 1.98, 95% confidence interval, CI, 1.10-3.54). The RR was 0.87 (0.34-2.22) for renal tumours, 0.66 (0.14-2.88) for penile cancer and 1.06 (0.76-1.48) for prostate cancer. For testicular tumours there was an inverse association with nitrate level, with a RR of 0.43 (0.21-0.90).
  
  
  CONCLUSIONS
  This study showed an association of nitrate load in drinking water and the incidence of urothelial cancer in both genders, with an inverse correlation to testicular tumours and no correlation with renal, penile and prostatic tumours.
authors.affiliation: Department of Urology, University of Ulm, Ulm, Germany. bjoern.volkmer@medizin.uni-ulm.de
authors.forename: Bjoern G
authors.initials: BG
authors.lastname: Volkmer
authors.forename: Birgitta
authors.initials: B
authors.lastname: Ernst
authors.forename: Joerg
authors.initials: J
authors.lastname: Simon
authors.forename: Rainer
authors.initials: R
authors.lastname: Kuefer
authors.forename: Georg
authors.initials: G
authors.lastname: Bartsch
authors.forename: Dietmar
authors.initials: D
authors.lastname: Bach
authors.forename: Juergen E
authors.initials: JE
authors.lastname: Gschwend
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000139:chemically induced* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000633:toxicity*; D011446:Prospective Studies; D014571:Urologic Neoplasms / Q000139:chemically induced* / Q000453:epidemiology; D014874:Water Pollutants, Chemical / Q000633:toxicity*; D014881:Water Supply
chemical_list: D009566:Nitrates; D014874:Water Pollutants, Chemical